Research Article Sonographic Differential Diagnosis in Deep Infiltrating Endometriosis: The Bowel Marco Scioscia , 1,2 Simone Orlandi, 3 Giamberto Trivella, 2 Antonella Portuese, 4 Stefano Bettocchi, 5 Giovanni Pontrelli, 1,2 Paolo Bocus, 3 and Bruna Anna Virgilio 1 1 Department of Obstetrics and Gynecology, Policlinico Hospital, Abano Terme, Padua, Italy 2 Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy 3 Department of Gastroenterology and Endoscopy, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy 4 Progetto Salute, Radiology Diagnostic Center, Verona, Italy 5 Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, Policlinico University of Bari, Bari, Italy Correspondence should be addressed to Marco Scioscia; marcoscioscia@gmail.com Received 2 May 2019; Accepted 28 August 2019; Published 28 October 2019 Academic Editor: Kyousuke Takeuchi Copyright©2019MarcoSciosciaetal.isisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. is case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis. 1. Introduction Endometriosis is a common disease of reproductive-age women with an estimated prevalence between 5 and 15% [1, 2]. Certainly, clinical history, pelvic bimanual exami- nation, and ultrasound represent the first-line methods to diagnose or to suspect endometriosis while a second-level ultrasound (ultrasound with an expert in the field) can improve the detection accuracy of most of the pelvic lo- cations of this disease [3]. e great difficulty in complete sonographic evaluation of pelvic endometriosis is mostly related to the variance in the appearance of endometriosis lesions and the distorted anatomy secondary to adhesions and fibrosis. In fact, endometriosis induces an intense re- active sterile inflammation that lead to the formation of adhesions and reactive fibrosis [4]. Furthermore, endome- triosis can extend to organs other than the genitalia in- cluding the bowel, the bladder, and retroperitoneal structures (ureters, parametria, and nerves) [5], thus con- founding the ultrasound evaluation [6]. Preoperative diagnosis of intestinal endometriosis has proven a challenge. Colonic endometriosis that affects about 37% of women with severe endometriosis is not a rare condition of the disease [5]. Correct diagnosis is funda- mental to formation of the appropriate treatment strategy [7]. In the recent years, the ultrasound detection rate of endometriosis foci of the bowel has increased (high sensi- tivity and specificity) [8, 9], with accuracy rates as high as other imaging techniques [10, 11]. e vast majority of studies evaluating ultrasound in bowel endometriosis are aimed at gauging the detection rate in all pelvic locations or a comparison of ultrasound with other imaging methods [10–12]. Comparison of data between the different published studies is difficult because of the heterogenicity in the ter- minology used to describe structures and anatomical loca- tions. In this regard, a consensus was published to standardize methodology and nomenclature in ultrasound for endometriosis [13]. However, none of them emphasized the important aspect of differential diagnosis. ere have been a limited number of studies describing the sonographic Hindawi BioMed Research International Volume 2019, Article ID 5958402, 9 pages https://doi.org/10.1155/2019/5958402