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Rectum, Rectosigmoid, and Sigmoid Endometriosis

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How to Perform Ultrasonography in Endometriosis

Abstract

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].

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References

  1. Chapron C, et al. Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Hum Reprod. 2010;25:884–9.

    Article  Google Scholar 

  2. Chapron C, et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod. 2006;21:1839–45.

    Article  Google Scholar 

  3. Bazot M, et al. Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod. 2007;22:1457–63.

    Article  Google Scholar 

  4. Kavallaris A, Köhler C, Kühne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod. 2003;18:1323–7.

    Article  CAS  Google Scholar 

  5. Remorgida V, et al. How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod. 2005;20:2317–20.

    Article  CAS  Google Scholar 

  6. Abrão MS, et al. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update. 2015;21:329–39.

    Article  Google Scholar 

  7. Podgaec S, Gonçalves MO, Klajner S, Abrão MS. Epigastric pain relating to menses can be a symptom of bowel endometriosis. Sao Paulo Med J. 2008;126:242–4.

    Article  Google Scholar 

  8. Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG. 2000;107:44–54.

    Article  CAS  Google Scholar 

  9. Simões Abrão M, et al. Rectal endoscopic ultrasound with a radial probe in the assessment of rectovaginal endometriosis. J Am Assoc Gynecol Laparosc. 2004;11:50–4.

    Article  Google Scholar 

  10. Chapron C, et al. Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis. Hum Reprod. 1998;13:2266–70.

    Article  CAS  Google Scholar 

  11. Bazot M, et al. Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod. 2003;18:1686–92.

    Article  Google Scholar 

  12. Takeuchi H, et al. A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril. 2005;83:442–7.

    Article  Google Scholar 

  13. Hottat N, et al. Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment—initial results. Radiology. 2009;253:126–34.

    Article  Google Scholar 

  14. Abrao MS, et al. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 2007;22:3092–7.

    Article  Google Scholar 

  15. Ribeiro HS, et al. [Double-contrast barium enema in the diagnosis of intestinal deeply infiltrating endometriosis]. Rev Bras Ginecol Obstet. 2008;30:400–5.

    Google Scholar 

  16. Biscaldi E, Ferrero S, Remorgida V, Rollandi GA. Bowel endometriosis: CT-enteroclysis. Abdom Imaging. 2007;32:441–50.

    Article  Google Scholar 

  17. Hudelist G, et al. Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Hum Reprod. 2009;24:1018–24.

    Article  CAS  Google Scholar 

  18. Guerriero S, et al. Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis. Hum Reprod. 2008;23:2452–7.

    Article  Google Scholar 

  19. Exacoustos C, et al. OC19.04: Sonographic evaluation of posterior deep pelvic endometriosis: endovaginal-, transrectal- and vaginosonography to assess the extension of the disease. Ultrasound Obstet Gynecol. 2005;26:340–1.

    Article  Google Scholar 

  20. Piketty M, et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod. 2009;24:602–7.

    Article  Google Scholar 

  21. Hudelist G, Tuttlies F, Rauter G, Pucher S, Keckstein J. Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? Hum Reprod. 2009;24:1012–7.

    Article  Google Scholar 

  22. Nisenblat V, et al. Combination of the non-invasive tests for the diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;(7):CD012281.

    Google Scholar 

  23. Guerriero S, et al. 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. Ultrasound Obstet Gynecol. 2016;48:318–32.

    Article  CAS  Google Scholar 

  24. Chapron C, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18:157–61.

    Article  Google Scholar 

  25. Goncalves MO, Podgaec S, Dias JA Jr, Gonzalez M, Abrao MS. 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. Hum Reprod. 2010;25:665–71.

    Article  Google Scholar 

  26. Abrão MS, et al. Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol. 2008;15:280–5.

    Article  Google Scholar 

  27. Ruffo G, et al. Laparoscopic colorectal resection for deep infiltrating endometriosis: analysis of 436 cases. Surg Endosc. 2010;24:63–7.

    Article  Google Scholar 

  28. Dousset B, et al. Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg. 2010;251:887–95.

    Article  Google Scholar 

  29. Goncalves MO, Dias JA Jr, Podgaec S, Averbach M, Abrão MS. Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis. Int J Gynaecol Obstet. 2009;104:156–60.

    Article  Google Scholar 

  30. Acien P, et al. Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement? Int J Womens Health. 2013;5:449–55.

    Article  Google Scholar 

  31. Young SW, et al. Initial accuracy of and learning curve for transvaginal ultrasound with bowel preparation for deep endometriosis in a US Tertiary Care Center. J Minim Invasive Gynecol. 2017;24(7):1170–6. https://doi.org/10.1016/j.jmig.2017.07.002.

    Article  PubMed  Google Scholar 

  32. Ros C, et al. Bowel preparation improves the accuracy of transvaginal ultrasound in the diagnosis of rectosigmoid deep infiltrating endometriosis: a prospective study. J Minim Invasive Gynecol. 2017;24(7):1145–51. https://doi.org/10.1016/j.jmig.2017.06.024.

    Article  PubMed  Google Scholar 

  33. Young SW, et al. Sonographic evaluation of deep endometriosis: protocol for a US radiology practice. Abdom Radiol (NY). 2016;41:2364–79.

    Article  Google Scholar 

  34. Panebianco V, et al. [Low anterior resection of the rectum using mechanical anastomosis in intestinal endometriosis]. Minerva Chir. 1994;49:215–7.

    Google Scholar 

  35. Duepree HJ, et al. Laparoscopic resection of deep pelvic endometriosis with rectosigmoid involvement. J Am Coll Surg. 2002;195:754–8.

    Article  Google Scholar 

  36. de Almeida A, Fernandes LF, Averbach M, Abrão MS. Disc resection is the first option in the management of rectal endometriosis for unifocal lesions with less than 3 centimeters of longitudinal diameter. Surg Technol Int. 2014;24:243–8.

    PubMed  Google Scholar 

  37. Pereira RMA, et al. Use of circular stapler for laparoscopic excision of rectosigmoid anterior wall endometriosis. Surg Technol Int. 2008;17:181–6.

    PubMed  Google Scholar 

  38. Kondo W, et al. Surgical techniques for the treatment of bowel endometriosis. J Minim Invasive Gynecol. 2015;22:S131.

    Article  CAS  Google Scholar 

  39. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67:817–21.

    Google Scholar 

  40. Reid S, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41:685–91.

    Article  CAS  Google Scholar 

  41. Hudelist G, et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013;41:692–5.

    Article  CAS  Google Scholar 

  42. Tammaa A, et al. Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod. 2014;29:1199–204.

    Article  Google Scholar 

  43. Millischer A-E, et al. Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results. Ultrasound Obstet Gynecol. 2015;46:109–17.

    Article  Google Scholar 

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Goncalves, M.O., de Mattos, L.A., Abrao, M.S. (2018). Rectum, Rectosigmoid, and Sigmoid Endometriosis. In: Guerriero, S., Condous, G., Alcázar, J.L. (eds) How to Perform Ultrasonography in Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-319-71138-6_12

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  • DOI: https://doi.org/10.1007/978-3-319-71138-6_12

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