Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

Hudelist, Gernot; Tuttlies, F; Rauter, G.; Pucher, Stefan; Keckstein, J.

doi:10.1093/humrep/dep014

Cited by 99 publications

(92 citation statements)

References 20 publications

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“…Ultrasound image of a dilated ureter seen by transvaginal ultrasound in a transverse section of the pelvis, as tubular anechoic structure (arrows) in the parametrial tissue laterally to the uterine cervix. the normal rectal wall layers are seen: the rectal serosa and smooth muscle layer appear as a thin, hypoechogenic line covered by the rectal submucosa and mucosa, which is visualised as a hyperechogenic rim covering the rectal smooth muscle layer [55]. With the posterior uterine wall, intestinal nodules located below the level of the insertion of the uterosacral ligaments (USLs) on the cervix are considered low rectal lesions (Fig.…”

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

“…Although reported sensitivity and specificity of transvaginal sonography in the prediction of DIE is high [47][48][49][50][51][52][53][54][55][56][57][58], evaluation of DIE by transvaginal sonography is difficult and requires expertise. Therefore, some easily detectable utrasonographic signs have recently been proposed to predict the risk of the presence of DIE.…”

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

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Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

211

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

211

143

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“…Pri diagnosticiranju endometrioze danke in sigmoidnega kolona se je s skoraj 100-odstotno občutljivostjo uveljavila kombinacija transvaginale in endorektalne ultrazvočne preiskave (7,8). Medikamentno zdravljenje GIE praviloma ni učinkovito (9), zato je za enkrat izbirni način zdravljenja endometrioze črevesa kirurški z vedno bolj uveljavlje-nim laparoskopskim pristopom (10,11).…”

Section: Uvodunclassified

“…Vzrokov za naraščanje števila resekcij črevesa je več: vse večja ozaveščenost o bolezni in zgodnejša diagnostika, sodobni minimalno invazivni diagnostični postopki (7,8) kakor tudi število kirurgov, usposobljenih za minimalno invaziven laparoskopski kirurški pristop.…”

Section: Razpravljanjeunclassified

Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze

2017

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Background: Te purpose of the study was to determine the quality of life in patients with bowel endometriosis before and afer laparoscopic bowel resection.Material and methods: In the retrospective study we included 91 patients who underwent laparoscopic resection of the bowel aﬀected by endometriosis at the Unit for Reproduction and the Unit for Gynecology, Department of Obstetrics and Gynecology Ljubljana, in the period from 2002 to 2011. Te study was retrospective. Te patients were sent a questionnaire regarding the symptoms before surgery and the eﬀect of surgery on bowel symptoms, painful menstruation, painful sexual intercourse, chronic pelvic pain and quality of life before and afer surgery; 76 (83.5 %) patients replied to the questionnaire.Results: Before surgery, 72 (94.7 %) patients reported painful menstruation. Improvement or complete relief afer surgery was registered in 57 (79.1 %). Out of 60 (78.9 %) patients who had painful sexual intercourse before surgery, 49 (81.7 %) reported improvement or complete relief afer surgery. Bowel symptoms, present in 52 (68.4 %) patients before surgery, improved or completely disappeared in 48 (92.4 %) afer surgery. Chronic pelvic pain, present in 53 (69.7 %) before surgery, decreased or did not exist any more in 45 patients (86.5 %). Te quality of life before surgery was very poor in 32 patients (42.1 %), and poor in 21 patients (27.8 %). Afer the operation, the quality of life was reported as improved in 22 (28.9 %) and signifcantly improved in 42 (55.3 %).Conclusions: Laparoscopic bowel resection, indicated in extensive symptomatic endometriosis, signifcantly improves the patients’ quality of life.

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“…Therefore, the injection of ultrasonography jelly in the vagina and the rectum during MRI has been proposed to facilitate the identification of intestinal lesions (Figure 4) [15] . Several studies have demonstrated that transvaginal ultrasonography may not only accurately diagnose the presence of rectosigmoid endometriosis but it may also estimate the depth of infiltration of the nodules in the intestinal wall [16][17][18][19][20] . However, it is well known that the diagnostic accuracy of ultrasonography depends on the experience of the operator.…”

Section: Diagnosismentioning

confidence: 99%

Bowel endometriosis: Recent insights and unsolved problems

Ferrero¹

2011

WJGS

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Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.

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Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum?

Abstract: TVS is a highly valuable tool in detecting rectal endometriosis preoperatively. Within this, S/M endometriotic infiltration can be accurately predicted, whereas TVS is less valuable for detection of MUC involvement.

Cited by 99 publications

References 20 publications

Imaging for the evaluation of endometriosis and adenomyosis

Imaging for the evaluation of endometriosis and adenomyosis

Kakovost življenja pred in po laparoskopski resekciji črevesa zaradi globoke infiltrativne endometrioze

Bowel endometriosis: Recent insights and unsolved problems

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