Surgical Management of Deep Endometriosis with Bilateral Endometriomas and Rectal Involvement

Patient: 26-year-old female with severe dysmenorrhea, dyspareunia, and dyschezia. She has a history of bilateral endometriomas and deep endometriosis involving both sacrouteral ligaments and rectum. 

Clinical History: Dysmenorrhea began at menarche, and she was prescribed oral contraceptive pills at age 16 but stopped in her 20s due to mental side effects. Symptoms worsened, leading to emergency care two years ago, where a cyst was discovered. 

Diagnostic: Suspected deep and severe endometriosis, December 2024.

Adhesiolysis. 

Cyst excision and suspension of the ovaries. 

Visualization of the ureters and excision of all endometriotic tissue bilaterally. 

Test for tube patency.