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Value of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum
Submitted 10 May 2004
Accepted after Revision 3 November 2004
12 April 2005 (online)
Background and Study Aims: Rectovaginal septal endometriosis (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 involvement 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 patients included in the study presented with suspected RVSE and underwent systematic anorectal endoscopic ultrasonographic exploration prior to the surgical intervention. The endoscopic ultrasonography was carried out under general anesthesia with a 7.5-MHz miniprobe equipped with a distal balloon.
Results: The anorectal endoscopic ultrasonographic examination (EUS) showed the presence of endometriosis in the rectovaginal 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 rectovaginal septum in 26 cases, the uterosacral ligaments in 22 cases, and the ovaries in 16 cases. The rectal wall was completely infiltrated in 12 cases and only partly in four cases, and intestinal tract resection was required in 10 cases. The sensitivity, specificity, and positive and negative predictive value of anorectal endoscopic ultrasonography as a means of diagnosing endometriosis of the rectovaginal septum and infiltration of the rectal wall were found to be 96 %, 100 %, 100 % and 83 %, and 92 %, 66 %, 64 % and 92 %, respectively; and the diagnostic accuracy was at 96 % and 80 %, respectively. The sensitivity for detecting nodules in the uterosacral ligaments or in the ovaries was 42 % and 14 %, respectively, leading to diagnostic accuracy rates of 56 % and 53 %.
Conclusions: In terms of its sensitivity and its negative predictive value, anorectal endoscopic ultrasonography is a very effective means of detecting endometriosis of the rectovaginal septum and assessing possible infiltration of the rectal wall. However, this method is not as accurate for nodules located far from the EUS probe, as is the case with the uterosacral ligaments and ovaries.
- 1 Camagna O, Dupuis O, Soncini E. et al . Surgical treatment of rectovaginal septum endometriosis in infiltrating endometriosis: from a continuous series of 40 cases. Acta Endosc. 2002; 32 47-53
- 2 Cornillie F J, Oosterlynck D, Lauweryns J M, Koninckx P R. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril. 1990; 53 978-983
- 3 Martin D C, Hubert G D, Levy B S. Depth of infiltration of endometriosis. J Gynecol Surg. 1989; 5 55-60
- 4 Dumontier I, Roseau G, Vincent B. et al . Comparison of endoscopic ultrasound and magnetic resonance imaging in pelvic endometriosis. Gastroenterol Clin Biol. 2000; 24 1197-1204
- 5 Koninckx R P, Meuleman C, Demeyere S. et al . Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991; 55 759-765
- 6 Nezhat F, Nezhat C, Pennington E. Laparoscopic treatment of infiltrating rectosigmoid colon and rectovaginal septum endometriosis by the technique of videolaparoscopy and the CO2 laser. Br J Obstet Gynecol. 1992; 99 664-667
- 7 Candiani G B, Vercellini P, Fedele L. et al . Conservative surgical treatment of rectovaginal septum endometriosis. J Gynecol Surg. 1992; 8 177-182
- 8 Chapron C, Dubuisson J B, Tardif D. et al . Retroperitoneal endometriosis infiltrating the utero-sacral ligaments: technique and results of laparoscopic surgery. J Gynecol Obstet Biol Reprod. 1997; 26 264-269
- 9 Chapron C, Jacob S, Dubuisson J B. et al . Laparoscopically assisted vaginal management of deep endometriosis infiltrating the rectovaginal septum. Acta Obstet Gynecol Scand. 2001; 80 349-354
- 10 Donnez J, Nisolle M, Gillerot S. et al . Rectovaginal septum adenomyotic nodules: a series of 500 cases. Br J Obstet Gynecol. 1997; 104 1014-1018
- 11 Koninckx R P, Timmermans B, Meuleman C. et al . Complications of CO2 laser endoscopic excision of deep endometriosis. Hum Reprod. 1996; 11 2263-2268
- 12 Martin D C. Laparoscopic and vaginal colpotomy for the excision of infiltrating cul-de-sac endometriosis. J Reprod Med. 1988; 33 806-808
- 13 Possover M, Plaul K, Schneider A. Laparoscopically assisted vaginal resection of rectovaginal endometriosis. Obstet Gynecol. 2000; 96 304-307
- 14 Redwine D B. Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease. Fertil Steril. 1991; 56 628-634
- 15 Redwine D B. Laparoscopic en bloc resection for treatment of the obliterated cul-de-sac in endometriosis. J Reprod Med. 1992; 37 695-698
- 16 Reich H, Glynn F, Salvat J. Laparoscopic treatment of cul-de-sac obliteration secondary to retrocervical deep fibrotic endometriosis. J Reprod Med. 1991; 36 516-522
- 17 Fedele L, Bianchi S, Portuese A. et al . Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol. 1998; 91 444-448
- 18 Schröder J, Löhnert M, Doniec J M. et al . Endoluminal ultrasound diagnosis and operative management of rectal endometriosis. Dis Colon Rectum. 1997; 40 614-617
- 19 Roseau G, Dumontier I, Palazzo L. et al . Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications. Endoscopy. 2000; 32 525-30
- 20 Tran K T, Kuijpers H C, Willemsen W N. et al . Surgical treatment of symptomatic rectosigmoid endometriosis. Eur J Surg. 1996; 162 139-141
- 21 Jenkins S, Olive D L, Haney A F. Endometriosis: pathogenetic implications of the anatomic distribution. Obstet Gynecol. 1986; 67 335-338
- 22 Redwine D B. The distribution of endometriosis in the pelvis by age groups and fertility. Fertil Streril. 1987; 47 173-175
- 23 Weed J C, Ray J E. Endometriosis of the bowel. Obstet Gynecol. 1987; 69 727-730
- 24 Zwas F R, Lyon D T. Endometriosis: an important condition in clinical gastroenterology. Dig Dis Sci. 1991; 36 353-364
- 25 Decocq J. Echographie de l’endométriose. J Echogr Med Ultrason. 1997; 18 15-23
- 26 Gorell H A, Cyr D R, Wang K Y, Greer B E. Rectosigmoid endometriosis: diagnosis using endovaginal sonography. J Ultrasound Med. 1989; 8 459-461
- 27 Togashi K, Nishimura K, Kimura I. et al . Endometrial cysts: diagnosis with MR imaging. Radiology. 1991; 180 73-78
M. Barthet, M. D.
Dept. of Gastroenterology · Hôpital Nord
13915 Marseilles · France