Relevance of Imaging Examinations in the Surgical Planning of Patients with Bowel Endometriosis

Endometriosis is a benign gynecologic disease characterized by the presence of endometrial tissue outside the uterine cavity. The complexity of the disease results from its multiple clinical presentations, the multifocal pattern of distribution of the lesions, the presence of extra pelvic sites of the disease (mainly affecting the urinary and the intestinal tracts), and the difficulty in the preoperative diagnosis (by means of imaging studies) and in the surgical treatment. The preoperative mapping of the lesions, either by ultrasound or by magnetic resonance imaging, allows for an adequate surgical planning and a better preoperative patient counseling, especially in those women with deep infiltrating endometriosis affecting the bowel. Also, the choice of the surgical team that is going to perform the procedure may be based on the preoperative workup. In this paper, we highlight the important findings that should be described in the imaging examination reports for the preoperative workup of patients with deep infiltrating endometriosis of the intestine.

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Hysteroscopic vaginoscopy. An additional diagnostic tool for recto-vaginal deep infiltrating endometriosis

Journal of Endometriosis and Pelvic Pain Disorders ◽

10.1177/2284026520967865 ◽

2020 ◽

pp. 228402652096786

Author(s):

Brunella Zizolfi ◽

Virginia Foreste ◽

Attilio Di Spiezio Sardo ◽

Pierluigi Giampaolino ◽

Annarita Gencarelli ◽

...

Keyword(s):

Bowel Resection ◽

Uterine Cavity ◽

Accurate Diagnosis ◽

Endometrial Tissue ◽

Deep Infiltrating Endometriosis ◽

Resonance Imaging ◽

Total Hysterectomy ◽

Segmental Bowel Resection ◽

History Of ◽

Infiltrating Endometriosis

Endometriosis is the presence of endometrial tissue outside the uterine cavity. Rectovaginal infiltration is present in 5% to 25% of the patients diagnosed with endometriosis. Accurate diagnosis is imperative for adequate counseling. Hysteroscopic vaginoscopy allows the inspection of the posterior vaginal fornix, not only providing better visualization of the area due to image magnification, but also allowing to obtain biopsy providing pathologic confirmation. We report the case of a 49-year-old nulliparous patient with long history of severe dysmenorrhea, deep dyspareunia and debilitating chronic pelvic pain not responding to medical treatment. On physical exam, recto-vaginal tender nodularity was palpated. Vaginal ultrasound and magnetic resonance imaging confirmed the presence of the nodular formation extending up to the rectum. In-office vaginoscopy revealed a perforated bulge on the uterine cervix, mimicking a double cervix. A biopsy of the nodule confirmed the presence of endometrial tissue, confirming the diagnosis of endometriosis. Patient underwent total hysterectomy with excision of deep infiltrating endometriosis which required segmental bowel resection with diverting loop colostomy. The final pathology confirmed the diagnosis of deep infiltrating endometriosis.

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Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options

BioMed Research International ◽

10.1155/2016/3617179 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 69

Author(s):

Antonio Simone Laganà ◽

Salvatore Giovanni Vitale ◽

Maria Antonietta Trovato ◽

Vittorio Italo Palmara ◽

Agnese Maria Chiara Rapisarda ◽

...

Keyword(s):

Uterine Cavity ◽

Laparoscopic Approach ◽

Deep Infiltrating Endometriosis ◽

Full Thickness ◽

Intestinal Endometriosis ◽

Deep Endometriosis ◽

Uterosacral Ligaments ◽

Intestinal Involvement ◽

Full Thickness Excision ◽

Infiltrating Endometriosis

Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.

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Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00526-w ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Samar M. El-Maadawy ◽

Nesreen Alaaeldin ◽

Charles B. Nagy

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Imaging Method ◽

Deep Infiltrating Endometriosis ◽

Patient Counselling ◽

Preoperative Mapping ◽

Significant Difference ◽

Operative Complications ◽

Infiltrating Endometriosis ◽

Post Operative Complications

Abstract Background Endometriosis is a challenging gynecological condition that has a profound influence on the quality of life of affected women. Transvaginal ultrasound is considered the first-line imaging method in preoperative assessment of the extent and severity of endometriosis. Accurate preoperative mapping can aid the surgeon in patient counselling, selection of the most appropriate surgical method that minimizes the operative and post-operative complications. The aim of our study is to evaluate the accuracy of transvaginal sonography (TVS) in precisely assessing the size, location and extent of deep infiltrating endometriosis (DIE) using a new modified endometriosis mapping proforma with histopathological confirmation. Our prospective observational study included 101 women with clinically suspected DIE who underwent TVS followed by laparoscopy from October 2018 to December 2020 with a maximum of 4 weeks interval. Precise mapping of DIE was done during TVS and laparoscopy. Results were correlated with histopathology findings. Results DIE was confirmed by histopathology in 88 patients. Sensitivity and specificity for individual DIE locations were rectovaginal septum 67.9% and 98.6%; vagina 52.2% and 98.7%; uterosacral ligaments 82.5% and 96.2%; torus 96.4% and 97.3%; parametrium 68.8% and 96.9%; rectum 100% and 98.8%; bladder 100% and 100%, ureters 63.4% and 99.0%; scar endometriosis 100% and 100%; pouch of Douglas obliteration 97.7% and 100%. No statistically significant difference was detected between ultrasound and histopathology size. Ultrasound tended to underestimate the lesion size; the underestimation was more pronounced for lesions > 3 cm. “Butterfly” and “tram-track” signs are two new sonographic signs related to posterior compartment DIE. No post-operative complications were recorded. There were no cases of DIE recurrence. Eleven out of 22 cases of infertility achieved pregnancy during 18 months follow-up. Conclusion TVS provides a thorough and accurate evaluation of the extent of endometriosis. An experienced radiologist can use E-PEP to provide an accurate demonstration of the location and extent of DIE which helps the surgeon select the most appropriate surgical approach ensuring radical treatment of the disease and minimizing short- and long-term complications.

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