Objective: Authors report their experience about a case of intestinal endometriosis that lead cyclic and recurrent rectal bleeding in a fertile-age woman. Design: Report of 1 case with multidisciplinary approach and surgical treatment. Surgical effectiveness evaluation and 2 years follow-up. Brief review on the recent literature and the diagnostic and therapeutic implications. Setting: Section of General and Thoracic Surgery. Department of General Surgery, Emergency and Organ Transplantation. Policlinico “Paolo Giaccone”, Palermo. Intervention: After correct and sure diagnosis, the patient was submitted to sigmoid segmental resection with radical and curative intention. Results: Complete recovery. Follow-up (24 months) negative. Conclusions: Diagnosis of endometriosis should be considered in women with recurrent monthly addominal pain and bowel symptoms, especially if accompanied by gynaecologic complaints, even because the significant symptoms overlap with the irritable bowel syndrome (IBS) and makes the differentiation extremely difficult. Treatment of GI endometriosis is best approached in collaboration between a gynecologist experienced and intestinal surgeon. The high accuracy and low complications suggested that EUS-FNA was effective for the correct histologic diagnosis of intestinal endometriosis.