Endometriosis is a common benign and proliferating chronic disease characterized by the existence of endometrial glands and stroma outside the uterus, which affects as many as 10% - 15% of women of reproductive age. Ectopic endometrial tissue shows the same cyclic changes under the influence of hormones as eutopic tissue in the uterus through different phases of the menstrual cycle. Deep infiltrating endometriosis (DIE) is defined as an endometrial lesion that infiltrates the peritoneum, penetrates the retroperitoneal space or pelvic wall minimal with depth 5 mm. More than 90% of intestinal endometriosis affects the rectum and distal colon. Surgical treatment is a curative method of treating DIE that requires complete removal of all endometrial implants and restoration of normal anatomical relationships. Pathognomonic signs are dyshesia, blood in the stool, diarrhea during menstruation, severe menstrual myctalgia, and spread of pain to the perineum. The diagnosis is made on the basis of clinical examination and transvaginal ultrasound, which is supplemented by magnetic resonance imaging if a deficient ultrasound finding is suspected or complex surgery is expected due to the location, strictures or proximity of delicate neurovascular structures. Laparoscopically, a secondary assessment of enlargement is performed intraoperatively and a surgical approach to this specific pathoanatomical finding is decided. Hormone therapy creates a hypoestrogenic condition that induces ectopic endometrial atrophy and allows control of painful symptoms by reducing intra- and peri-lesion inflammation of endometrial nodules. Low-dose progestins or in combination with oral contraceptives are generally well tolerated and are the therapy of choice. The surgical approach falls into three categories: shaving excision, disc resection, and segmental resection. Shaving excision is the name for the removal of lesions layer by layer until healthy underlying tissue is reached and is indicated if the DIE lesion does not involve the intestinal wall deeper than the muscle layer. Discoid resection is operated on singular nodules, smaller than 3 cm, which infiltrate the wall deeper than the muscle layer and involve less than 1/3 of the circumference of the wall. Segmental resection has a large place in the therapy of DIE bowel because there are simply lesions that are not suitable for more conservative techniques according to the above indications. Indications for segmental resection are lesions> 3 cm, lesions involving> 2/3 of the circumference, or in the presence of bowel obstruction.