Endometriosis is one of the most common causes for young women undergoing major surgery. The exact etiology is unknown but appears to be related to retrograde menstruation. The predominant symptoms are pelvic pain and infertility. Diagnosis and treatment are usually based on findings at laparoscopy. Colon and rectal surgeons become involved usually assisting gynecologists with patients who have severe advanced disease that both creates a frozen pelvis and invades the anterior rectal wall. The best procedure to remove this nodule depends on the size and depth of the implant. Minimizing morbidity is critical in these young, otherwise, healthy patients.