Study Objective To determine the prevalence of palpable non-visualized bowel endometriotic nodules in women having a laparoscopic-assisted segmental bowel resection for large endometriotic lesions and to compare the operative findings and early postoperative complications with and without palpable non-visualized lesions. Design Observational with follow-up of 2.8 months to 1.2 years. Setting Multispecialty center. Patients or Participants Forty-nine patients with large endometriotic lesions of the rectum or sigmoid colon who underwent segmental resection. Interventions The patients underwent laparoscopic dissection and placement of the distal stapling devise and then exteriorization of the specimen through a small suprapubic incision. The proximal stapler was applied after a modification of the standard procedure that consisted of palpation anticipating small palpable lesions and to include those in the specimen. Hand-assisted laparoscopy and using rectal probes for recognition were not studied. Measurements and Main Results Eleven (22.4%) of the 49 patients who underwent sigmoid or rectal resection were found to have palpable non-visualized lesions of 2 mm to 10 mm. The median length of the proximal resected segment increased by 10 mm (range 5-30 mm) compared to the group with no such lesions. The was no difference in the short-term complication rate between the two groups. Conclusion This suggests that palpation for recognition, diagnosis, and treatment is useful in 22.4% of women undergoing laparoscopic-assisted colon resection for stapler placement. The presence of palpable, non-visualized endometriotic lesions adds to the controversy about the type of surgery needed for symptomatic endometriosis of the rectum and sigmoid colon. Although only 1% to 5% of patients have repeat surgery for symptomatic recurrence, the use of focused palpation may lower that further. The use of hand-assisted laparoscopy or rectal probes for recognition also need investigation.