{"paper_id":"ba16cd83-28fe-45d9-9eff-df3ed09dcf37","body_text":"Subscribe to RSS\nDOI: 10.1055/s-2005-861115\nValue of Endorectal Ultrasonography for Diagnosing Rectovaginal Septal Endometriosis Infiltrating the Rectum\nPublication History\nSubmitted 10 May 2004\nAccepted after Revision 3 November 2004\nPublication Date:\n12 April 2005 (online)\nBackground and Study Aims: Rectovaginal septal endometriosis (RVSE) can pose serious therapeutic problems when\nthere is infiltration of the rectal septum (which occurs in approximately half of\nthe cases). The aim of this study was to assess the value of endoscopic ultrasonography\nin diagnosing rectal wall involvement by pelvic endometriosis.\nPatients and Methods: A prospective study was carried out from May 1998 to March 2003 at a single hospital\ncenter. The 30 patients included in the study presented with suspected RVSE and underwent\nsystematic anorectal endoscopic ultrasonographic exploration prior to the surgical\nintervention. The endoscopic ultrasonography was carried out under general anesthesia\nwith a 7.5-MHz miniprobe equipped with a distal balloon.\nResults: The anorectal endoscopic ultrasonographic examination (EUS) showed the presence of\nendometriosis in the rectovaginal septum in 26 patients (88 %), in the uterosacral\nligaments in 10 patients (33 %), and in the ovaries in two patients (6 %). At EUS,\nthe nodules were infiltrating the rectal wall in 17 patients (56 %). The surgical\nexploration demonstrated endometriosis in the rectovaginal septum in 26 cases, the\nuterosacral ligaments in 22 cases, and the ovaries in 16 cases. The rectal wall was\ncompletely infiltrated in 12 cases and only partly in four cases, and intestinal tract\nresection was required in 10 cases. The sensitivity, specificity, and positive and\nnegative predictive value of anorectal endoscopic ultrasonography as a means of diagnosing\nendometriosis of the rectovaginal septum and infiltration of the rectal wall were\nfound to be 96 %, 100 %, 100 % and 83 %, and 92 %, 66 %, 64 % and 92 %, respectively;\nand the diagnostic accuracy was at 96 % and 80 %, respectively. The sensitivity for\ndetecting nodules in the uterosacral ligaments or in the ovaries was 42 % and 14 %,\nrespectively, leading to diagnostic accuracy rates of 56 % and 53 %.\nConclusions: In terms of its sensitivity and its negative predictive value, anorectal endoscopic\nultrasonography is a very effective means of detecting endometriosis of the rectovaginal\nseptum and assessing possible infiltration of the rectal wall. However, this method\nis not as accurate for nodules located far from the EUS probe, as is the case with\nthe uterosacral ligaments and ovaries.\nReferences\n- 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\n- 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\n- 3 Martin D C, Hubert G D, Levy B S. Depth of infiltration of endometriosis. J Gynecol Surg. 1989; 5 55-60\n- 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\n- 5 Koninckx R P, Meuleman C, Demeyere S. et al . 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