Deep infiltrating endometriosis (DIE) is a form of endometriosis that affects deeper layers of tissue beyond the peritoneum, such as the rectovaginal septum, rectum, bladder, and other pelvic organs. It is characterized by the formation of nodules, adhesions, and fibrosis that can invade the surrounding tissue, causing pain and dysfunction. DIE is considered the most severe form of endometriosis and can have a significant impact on a woman’s quality of life.

The exact prevalence of DIE is unknown, but estimates range from 20-50% of women with endometriosis. Diagnosis of DIE can be challenging, as it requires a combination of clinical examination, imaging studies, and histological confirmation.

Treatment for DIE often involves a multidisciplinary approach, with a focus on the excision or removal of affected tissue, as well as the preservation of reproductive function. Surgical management may involve laparoscopy or laparotomy, depending on the extent and severity of the disease. Medical management, such as hormonal therapy, may also be used to control symptoms and prevent a recurrence.

Here are some references to support the information on deep infiltrating endometriosis:

• Vercellini, P., Consonni, D., Dridi, D., Bracco, B., Frattaruolo, M. P., Somigliana, E., & Fedele, L. (2019). Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Human Reproduction Update, 25(6), 683-707. https://doi.org/10.1093/humupd/dmz019
• Hudelist, G., Fritzer, N., Staettner, S., Pucher, S., Kos, A., & Czerwenka, K. (2012). Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound in Obstetrics & Gynecology, 39(3), 336-341. https://doi.org/10.1002/uog.10058
• Koninckx, P. R., Meuleman, C., Demeyere, S., Lesaffre, E., & Cornillie, F. J. (1996). Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertility and Sterility, 66(3), 356-360. https://doi.org/10.1016/S0015-0282(16)58293-8

These references provide additional information on the diagnosis and management of deep infiltrating endometriosis.