Routine Clinical Examination Is Not Sufficient for Diagnosing and Locating Deeply Infiltrating Endometriosis

Chapron, Charles; Dubuisson, Jean; Pansini, Valeiria; Vieira, Marco; Fauconnier, Arnaud; Barakat, Habib; Dousset, B.

doi:10.1016/s1074-3804(05)60117-x

Cited by 142 publications

(95 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During this process, existence of a nodule must be sought during the vaginal touch. Even though, most clinicians sought for nodular lesion (a most standard form observed), it is not a must-to-follow rule [11,12]. It is also true that the outcome of clinical examination varies per the physical location of the lesion.…”

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

“…With a close examination with the speculum that finds lesions evocative of endometriosis, the upper third of the posterior surface of the vagina is infiltrated. Nevertheless, this proportion is significantly far lower in cases where the bowel or uterosacral ligaments are involved [11]. On the same note, lesions affecting vagina results in more frequent palpation of a nodule or painful infiltration during the vaginal touch [11].…”

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

“…Nevertheless, this proportion is significantly far lower in cases where the bowel or uterosacral ligaments are involved [11]. On the same note, lesions affecting vagina results in more frequent palpation of a nodule or painful infiltration during the vaginal touch [11]. So, the surgical practice must systematically include a rectal touch.…”

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

See 2 more Smart Citations

Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)

Simedrea¹

2015

Surgery

View full text Add to dashboard Cite

Journal of Surgery BackgroundEndometriosis is a painful and chronic gynecologic disorder, characterized by the presence of ectopic endometrium outside the endometrial cavity. Under this situation endometrial cells are implanted ectopically, that lead to retrograde menstruation via the fallopian tubes into the pelvis [1]. Endometriosis affects at least 6.3 million women and girls predominantly of reproductive age in the United States, 1 million in Canada, and millions more worldwide. It is associated with pelvic pain and infertility [2]. Peritoneal endometriosis, ovarian endometriosis and DIE are the three clinical presentations of endometriosis that have been described before [3]. Furthermore, several classifications of DIE have been proposed. In one classification, three different types of DIE are distinguished [4]: (I) A large lesion in the peritoneal cavity, infiltrating conically with the deeper parts becoming progressively smaller is designated as type-1; (II) In type-2, the bowel is being retracted over the lesion, and becomes deeply situated in the rectovaginal septum without infiltrating it; (III) Spherically shaped lesions, situated deep in the rectovaginal septum, and are often only visible as a small typical lesion at laparoscopy or often not visible at all. In the year 1995, Donnez and Nisolle have proposed only two types of DIE, first being caused by the invasion of a very active peritoneal lesion deep in the retroperitoneal space. In cases of lateral peritoneal invasion, utero-sacral ligaments can be involved as well as the anterior wall of the recto-sigmoid bowel junction resulting in a retraction, adhesions and secondary obliteration of the cul-desac. A second type is pseudo-DIE where the lesion originates from the rectovaginal septum tissue and consists essentially of smooth muscle with active glandular epithelium and scanty stroma [5].Today it is believed that endometriotic lesions can penetrate deep either into the retroperitoneal space or into the walls of the pelvic organs [6]. However, the mechanism is not clear and little is known about the impact of the different types of surgery in the treatment of DIE on complications, pain, patients' quality of life (QOL), recurrence rate and pregnancy rate or fertility. The aim of this review is therefore to evaluate the quality of life improvement after the different surgical modalities for management of DIE based on the above-mentioned parameters. Material and MethodIn this review we have searched The PUBMED (March 2005 to July 2015) for relevant articles. Heading terms "deep infiltrating endometriosis, quality of life" (n1=33) and "deep infiltrating endometriosis" (n2=402) were used. All pertinent articles were retrieved without any language restriction. To ensure the relevance of the publications, additional inclusion criteria were applied. We have included only those studies that contained a clear explanation of the surgical technique, an effectual evaluation of pain and an explicit description of post-operative QOL. To ensure a complete review o...

show abstract

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

Section: Surgical Versus Conservative Managementmentioning

confidence: 99%

See 1 more Smart Citation

Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)

Simedrea¹

2015

Surgery

View full text Add to dashboard Cite

show abstract

“…Clinical examination alone does not seem to be a good method for detecting peritoneal endometriosis [157]. The sensitivity and specificity of ultrasound and MRI with regard to various forms of peritoneal endometriosis are shown in Table 9 [158][159][160][161][162][163][164][165][166][167].…”

Section: Endometriosismentioning

confidence: 99%

Imaging in gynecology

Valentin

2006

Best Practice & Research Clinical Obstetrics & Gynaecol

View full text Add to dashboard Cite

This chapter summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of ultrasound, computer tomography, and magnetic resonance imaging in the diagnosis of various gynecological diseases and tumors. Positron emission tomography is not discussed. Imaging in infertility, in the diagnosis of Mullerian duct anomalies and in gynecological oncology (staging of gynecological cancers, diagnosis of recurrence of gynecological cancer, diagnosis of trophoblastic tumors) is not dealt with.Ultrasound is the first line imaging method for discrimination between viable intrauterine pregnancy, miscarriage and tubal pregnancy in women with bleeding and/or pain in early pregnancy, for discrimination between benign and malignant adnexal masses and for making a specific diagnosis in adnexal tumors (e.g., dermoid cyst, endometrioma, hemaorrhagic corpus luteum, ectetera), for diagnosing intracavitary uterine pathology in women with bleeding problems, and for confirming or refuting pelvic pathology in women with pelvic pain. Magnetic resonance imaging may have a role as a secondary test in the diagnosis of adenomyosis, 'deep endometriosis' (e.g., endometriosis in the rectovaginal septum or in the utero-sacral ligaments), and in the diagnosis of extremely rare types of ectopic pregnancy (e.g., in the spleen, liver or retroperitoneum).

show abstract

“…The recent trend is to prefer nodule excision, when feasible, than radical digestive resection [8,9] , therefore it is of utmost importance to appreciate endometriotic rectal and sigmoid infiltration, in the pre-operative staging. Diagnosis of recto-sigmoid endometriosis definitely relies on imaging as clinical examination is not sufficient for the diagnosis of location of deeply infiltrating endometriosis [10] . Since the early 1980's different techniques, from barium enema to the most recent magnetic resonance imaging (MRI), have been proposed and evaluated to achieve diagnosis of endometriosis [3,[11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis

Roseau¹

2014

WJGE

View full text Add to dashboard Cite

Recto-sigmoid endoscopic ultrasonography (RS-EUS) has first been used in the staging of pelvic deep infiltrating endometriosis in the early 1990's. Since then, although publications have been sparse, RS-EUS is routinely used for this indication in few centers. In this paper, we focus on technical aspects and operating method of rectal and sigmoid endo-sonography, and describe the most characteristic echographic presentations of endometriosis of the lower digestive tract. Through a literature review, results obtained with different types of endo-rectal probes, either flexible endoscopic, or blind rigid, are presented and compared with those of other close imaging techniques: magnetic resonance imaging and the more recent trans-vaginal sonography. As well as these two latter techniques, RS-EUS appears as an interesting method in the staging of pelvic deep infiltrating endometriosis particularly to evaluate rectal and sigmoid infiltrations. However, more prospective studies are required, to correctly define respective indications for each exam, in the light of recent advancements in treating this frequent disease. Key words: Endometriosis; Rectum and sigmoid; Ultrasound; Endoscopic-ultrasonography; Surgical treatment; Magnetic resonance imaging Core tip: Pelvic deep infiltrating endometriosis is a disabling disease of increasing rate. Today new medical and surgical therapies are proposed in the management of pain and infertility, and the choice of an optimal treatment strategy requires a precise anatomic evaluation. Several imaging techniques are available, either additive or competitive, in this staging. Rectosigmoid endoscopic-ultrasonography (RS-EUS), is routinely used in the field of gastroenterology, mostly for staging of rectal cancer. Few studies have demonstrated it could also be of interest to image endometriotic rectosigmoid infiltrations. In this review, we tried to assess indications and results of RS-EUS, compared to those of magnetic resonance imaging and transvaginal sonography.Roseau G. Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis. World J Gastrointest

show abstract

Routine Clinical Examination Is Not Sufficient for Diagnosing and Locating Deeply Infiltrating Endometriosis

Cited by 142 publications

References 26 publications

Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)

Quality of Life Improvement after Surgery for Deep Infiltrating Endometriosis (DIE)

Imaging in gynecology

Recto-sigmoid endoscopic-ultrasonography in the staging of deep infiltrating endometriosis

Contact Info

Product

Resources

About