M.O. Gonçalves

Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy

BACKGROUND Successful surgical treatment of deep bowel endometriosis depends on obtaining detailed information about the lesions, prior to the procedure. The objective of this study was to determine the capability of transvaginal ultrasonography with bowel preparation (TVUS-BP) to predict the presence of one or more rectosigmoid nodules and the deepest bowel layer affected by the disease. METHODS A prospective study of 194 patients with clinical and TVUS-BP suspected deep endometriosis submitted to videolaparoscopy. Image data were compared with surgical and histological results. RESULTS With respect to bowel nodule detection and presence of at least two rectosigmoid lesions, TVUS-BP had a sensitivity of 97 and 81%, specificity 100 and 99%, positive predictive value (PPV) 100 and 93% and negative predictive value (NPV) 98 and 96%, respectively. Regarding diagnosis of infiltration of the submucosal/mucosal layer, TVUS-BP had a sensitivity of 83%, specificity 94%, PPV 77%, NPV 96%. CONCLUSIONS These findings show that TVUS-BP is an adequate exam for evaluating the presence of one or more rectosigmoid nodules and the deepest layer affected in deep infiltrating bowel endometriosis, confirming the importance of this technique for defining the most appropriate surgical strategy to be implemented.

Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements : A consensus opinion from the International Deep Endometriosis Analysis (IDEA) group

The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright

Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis

To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) findings relative to surgical presence of deeply infiltrating endometriosis (DIE).

Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis

Deeply infiltrating endometriosis is the clinical form of the disease that is generally associated with conditions of more intense pain and may require more complex surgical management, consequently resulting in greater risks to the patient. In recent years, various investigators have confirmed the usefulness of methods such as magnetic resonance imaging (MRI), transrectal ultrasound and transvaginal ultrasound (TVUS) for the diagnosis of deep endometriotic lesions. The objectives of the present study are to describe the method used to perform TVUS for the detection of deeply infiltrating endometriosis, and to discuss the clinical benefits that the data obtained may offer clinicians providing care for patients suspected of having this type of endometriosis.

Epigastric pain relating to menses can be a symptom of bowel endometriosis

CONTEXT AND OBJECTIVE Endometriosis is a common affliction that may affect the intestinal tract. The objective of this case report was to describe an unusual clinical presentation of this form of the disease. CASE REPORT The patient was a 35-year-old woman with epigastric pain that only occurred during menstruation, who had a history of bladder endometriosis. Endoscopy of the upper digestive tract showed normal results. Transvaginal ultrasound and nuclear magnetic resonance of the pelvis showed a lesion involving the ileocecal junction and appendix, measuring 30 x 22/x/13/mm, that was suggestive of endometriosis. The patient underwent laparoscopic resection of the bowel segment affected by the disease, followed by anastomosis of the ileum and ascending colon for immediate restoration of intestinal transit. Histological analysis confirmed the diagnosis of endometriosis. CONCLUSIONS In young women, recurrent epigastric pain should be evaluated with regard to its relationship to menstruation, particularly if there is a history of endometriosis, since this may be a clinical sign that the disease is affecting the intestinal transit.

Transvaginal ultrasound after bowel preparation to assist surgical planning for bowel endometriosis resection

up 3 as those more than The rectosigmoid colon (RSC) is involved in up to 93% of all endometriotic lesions of the bowel [1]. Preoperative diagnosis of bowel endometriosis is very important for surgical planning and patient counseling. In this context, estimation of the distance from endometriotic lesions to the anal border hasmajor surgical implications because the risk of complications is greater for gastrointestinal anastomosis performed below the peritoneal reflection, in the lower rectum (less than 5 cm from the anal border) [2]. From the authors’ personal experience (MOCG and LPC), transvaginal ultrasound after bowel preparation (TVS-BP) improves the detection and characterization of intestinal lesions, permitting identification of the affected layers and the distance between the lower margin of the lesions and the anal border. Fifty-one patients who presented with endometriosis-associated infertility at the Huntington Medicina Reprodutiva Sao Paulo, Brazil, from October 2005 to October 2006 underwent TVS-BP measurement of the distance between RSC lesions to the anal border, and laparoscopic excision of endometriosis. Eighteen bowel lesions were resected in 16 women. During surgery, the actual distances between the endometriotic lesions and the anal border were recorded as the distance from the insertion of an endoscopic stapler at the anal border up to where the tip of the stapler touched the lesion. Lesions were divided into 3 groups based on their distance from the anal border, with group 1 categorized as those from1–5 cm (1/18; 5.6%); group 2 as those 6–10 cm (9/18; 50%); and gro

A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma

Ovarian endometriosis is present in 17%–44% of women with endometriosis. The main treatment is surgery, but ultrasonography‐guided aspiration is a less invasive alternative.

Rectum, Rectosigmoid, and Sigmoid Endometriosis

Deep intestinal endometriosis (DIE) is defined as nodules infiltrating at least the muscularis propria layer [1]. Lesions with dense adhesions and/or endometriotic infiltration up to the bowel serosa are not considered DIE. Statistical analysis of groups considered as reference in highly complex surgeries demonstrates that up to 50% of endometriotic patients may have intestinal involvement [2, 3].