• P. De Nardi
  • S. Ferrari


Endometriosis, defined as the presence of endometrial gland tissue and stroma outside the uterus, is a common disease with an estimated prevalence of 10% in women of reproductive age. Deep pelvic endometriosis is a specific entity defined by endometriotic lesions extending more than 5 mm under the peritoneum, usually located in the pouch of Douglas and in the connective tissue of the rectovaginal septum, that may involve the uterosacral ligaments, the rectum or the rectosigmoid junction, and the urinary tract.

Several theories have been proposed for the pathogenesis of deep pelvic endometriosis, namely the implantation of regurgitated endometrium, the theory of Müllerian or coelomic remnants metaplasia, the direct transplantation theory, and the theory of dissemination through the lymphatic and blood vessels.

The most-used classification-system for endometriosis is currently The American Fertility Society revised (r-AFS) classification, but other systems have been proposed by Konincks and Martin, Martin and Butt, Adamyan, and, more recently, by Chapron. Unfortunately, no system is universally shared.


r-ASF Peritoneum Cul-de-sac Pouch of Douglas 


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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • P. De Nardi
    • 1
  • S. Ferrari
  1. 1.Department of SurgerySan Raffaele Scientific InstituteMilanItaly

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