Algorithm for symptom-based treatment of colorectal endometriosis*

GI: gastrointestinal; MR: magnetic resonance; CT: computed tomography.
* This algorithm reflects our approach to choosing medical or surgical therapy for colorectal endometriosis. For further details on medical regimens and selection, surgical resection approaches, surgical complications, and approach to follow-up, refer to related UpToDate content.
¶ Detailed evaluation and confirmation of disease is advised because of the potential morbidity of surgery, particularly repeat surgery. For more information, refer to UpToDate content on the treatment of bowel and rectovaginal endometriosis.
Δ Risks of surgical resection of colorectal endometriosis include genital tract fistulae, bladder dysfunction, or bowel anastomotic leakage.
◊ In the authors' practice, every follow-up evaluation includes assessment of the patient's symptoms, physical examination, and repeat transvaginal sonography. The authors also perform urinary tract ultrasonography every six months. Once a patient's symptoms and examination have been stable for one year, the time interval between follow-up visits is lengthened.