Rectosigmoid endometriosis. Diagnosis using endovaginal sonography.

Gorell, H A; Cyr, D R; Wang, K Y; Greer, Benjamin E.

doi:10.7863/jum.1989.8.8.459

Cited by 27 publications

(13 citation statements)

References 1 publication

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“…The ini− tial methods used ± barium enema, coloscopy, and scanography ± were found to have fairly weak sensitivities of 22 %, 33 %, and 67 %, respectively [4]. Vaginal ultrasonography is thought to be a more sensitive test for detecting lesions in the lower intestinal tract, but the use of this exploratory approach is considered to be limited, as it cannot be applied above the vaginal cul−de−sac [4,25,26]. However, in this prospective series, the accuracy of transvaginal ultrasonography was rather disappointing in view Original Article of the low diagnostic accuracy (16 %) for rectovaginal septal no− dules ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum

Delpy¹,

Barthet²,

Gasmi³

et al. 2005

Endoscopy

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Rectovaginal septum endometriosis (RVSE) is a deep form of en− dometriosis in which the subperitoneal space is infiltrated by en− dometrial tissue to depths of up to 5 mm [1 ± 3]. The condition nearly always occurs in women of childbearing age, and the mean prevalence is 10 % (range 5 ±17 %) [4]. Some authors have suggested that endometriosis may occur more frequently at this particular site than the data available suggest [1, 3, 5, 6], but no consensus has been reached so far on this point.The standard treatment applied nowadays is surgery with com− plete excision of all the endometriosis encountered [1, 6 ± 16]. The rectovaginal lesions that are mainly responsible for the symptoms of this disease require specific forms of treatment. Gy− necologists should be informed before surgery about the extent to which the rectal septum is infiltrated by nodules. Surgery can be mandatory, but should not be the same if there is infiltration of the rectal wall.Background and Study Aims: Rectovaginal septal endometrios− is (RVSE) can pose serious therapeutic problems when there is infiltration of the rectal septum (which occurs in approximately half of the cases). The aim of this study was to assess the value of endoscopic ultrasonography in diagnosing rectal wall involve− ment by pelvic endometriosis. Patients and Methods: A prospective study was carried out from May 1998 to March 2003 at a single hospital center. The 30 pa− tients included in the study presented with suspected RVSE and underwent systematic anorectal endoscopic ultrasonographic exploration prior to the surgical intervention. The endoscopic ul− trasonography was carried out under general anesthesia with a 7.5−MHz miniprobe equipped with a distal balloon. Results: The anorectal endoscopic ultrasonographic examina− tion (EUS) showed the presence of endometriosis in the rectovag− inal septum in 26 patients (88 %), in the uterosacral ligaments in 10 patients (33 %), and in the ovaries in two patients (6 %). At EUS, the nodules were infiltrating the rectal wall in 17 patients (56 %). The surgical exploration demonstrated endometriosis in the rec−

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Section: Discussionmentioning

confidence: 99%

Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum

Delpy¹,

Barthet²,

Gasmi³

et al. 2005

Endoscopy

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“…However, imaging techniques such as ultrasonography, MRI and CT still have a role. The use of transvaginal ultrasonography is largely confined to lesions distal to the rectosigmoid junction 12. MRI has been studied extensively but altered signal patterns can make it difficult to delineate histological components of an endometrioma.…”

Section: Discussionmentioning

confidence: 99%

Endometriosis: a rare cause of small bowel obstruction

et al. 2012

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Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.

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“…Computed tomography has a limited role in imaging the female genital organs but can provide important information on involvement of the gastrointestinal tract,17 although transrectal ultrasonography offers higher sensitivity for pathology such as invasive rectovaginal endometriosis 18. Magnetic resonance imaging (MRI) is useful in characterizing pelvic masses as well as diagnosing adenomyosis, endometriomata, or deep endometriosis but its use is limited by high cost and varying availability.…”

Section: A Pragmatic Approach To Women With Chronic Cyclical Pelvic Painmentioning

confidence: 99%

Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach

Abbott¹

2010

IJWH

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This article reviews the literature on management of chronic cyclical pelvic pain (CCPP). Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all subheadings and keywords: “cyclical pelvic pain”, “chronic pain”, “dysmenorrheal”, “nonmenstrual pelvic pain”, and “endometriosis”. There is a dearth of high-quality evidence for this common problem. Chronic pelvic pain affects 4%–25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. Management options range from simple to invasive, where simple medical treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s) of the pain and its optimal management.

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Rectosigmoid endometriosis. Diagnosis using endovaginal sonography.

Abstract: Endometriosis is a relatively common disorder in women of childbearing age. Involvement is largely related but not entirely confined to the pelvis. We present a case of endometriosis involving the anterior rectal wall that was detected using endovaginal ultrasound scanning.

Cited by 27 publications

References 1 publication

Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum

Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum

Endometriosis: a rare cause of small bowel obstruction

Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach

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