Magnetic resonance imaging (MRI) is a very useful tool in delineating cases of severe endometriosis with involvement of the bowel, bladder, ovaries, uterus and fallopian tubes. It can also identify adenomyosis, endometriosis within the myometrium of the uterus, which is a cause of severe dysmenorrhoea and pelvic pain. Where uretric involvement is suspected then an intravenous urogram (IVU) is of assistance in identifying the level of extrinsic ureteic constriction.
Two important markers for severe pelvic endometriosis are the presence of hydrosalpinges and endometriomas. Both should result in carefully planned treatment with the use of bowel preparation prior to surgery. They are both highly associated with infertility as well as pelvic pain.