13655 Posterior Deep Infiltrating Endometriosis: Is Patient-Reported Dyschezia a Reliable Clinical Indicator?

Document Type

Conference Proceeding

Publication Date

11-1-2025

Publication Title

J Minim Invasive Gynecol

Abstract

Study Objective: To assess the association between patient-reported dyschezia and posterior compartment involvement in deep infiltrating endometriosis (DIE). Design: Retrospective cohort study. Setting: Academic-affiliated health system. Patients or Participants: Electronic medical records were reviewed for patients who underwent minimally invasive surgical excision of endometriosis between September 2019 and January 2025. All included patients had pathology-confirmed endometriosis. Data on preoperative dyschezia, imaging findings, and anatomic distribution of disease were extracted from clinic notes, operative reports, and pathology records. Interventions: None. Measurements and Primary Results: Among 165 patients with pathology-confirmed endometriosis, 52 (32%) reported dyschezia preoperatively, 55 (33%) did not, and 58 (35%) had no documented assessment of dyschezia. Of those who reported dyschezia, 40 (77%) had disease involving the posterior pelvic compartment. Patients with dyschezia had nearly threefold higher odds of posterior compartment involvement compared to those without dyschezia (OR 2.99, 95% CI 1.30–6.88, P<0.05). More specifically, dyschezia was associated with endometriosis involving the anterior rectal wall (OR 3.05, 95% CI 1.26–7.36, P<0.05), uterosacral ligaments (OR 2.38, 95% CI 1.10–5.19, P<0.05), and rectovaginal septum (OR 7.95, 95% CI 1.68–37.54, P<0.05). In contrast, dyschezia was not statistically significantly associated with preoperative MRI findings of bowel or rectal involvement (OR 1.7, 95% CI 0.45–6.41, P=0.43). However, when such findings were present on MRI, they were associated with posterior DIE on pathology (OR 5.12, 95% CI 1.14–22.90, P<0.05). Conclusion: Dyschezia is a strong clinical predictor of endometriosis involving the posterior pelvic compartment, specifically the anterior rectal wall, uterosacral ligaments, and rectovaginal septum. While dyschezia did not correlate with bowel or rectal involvement on preoperative MRI, positive imaging findings in these locations were associated with posterior DIE. Patient-reported dyschezia offers valuable diagnostic insight, particularly when imaging may underrepresent the extent of disease. Identifying this symptom can help guide surgical planning and better estimate the burden of posterior involvement.

Volume

32

Issue

11

First Page

S77

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