{"paper_id":"c81ad351-2a53-4844-826f-3c7cad697f29","body_text":"ECR 2026 / C-15039\nEndometriosis Findings on Transvaginal Ultrasound without Bowel Preparation: a StepwiseApproach\nCongress:\nECR 2026\nPoster Number:\nC-15039\nType:\nEducational Exhibit\nKeywords:\nGenital / Reproductive system female, Ultrasound, Education, Education and training\nAuthors:\nE. M. J. De Barros, P. Takieddine, A. Borges, A. Carvalho Dias, G. G. Cerri, R. A. Garcia Jureidini, J. A. B. Araújo-Filho\nDOI:\n10.26044/ecr2026/C-15039\nLearning objectives\nTo highlight the role of transvaginal ultrasonography without bowel preparation in suspected endometriosis;\nTo demonstrate structured and dynamic scanning strategies for disease detection;\nTo identify limitations and indications for complementary imaging.\nBackground\nEndometriosis is a major cause of chronic pelvic pain and infertility. Deep infiltrative endometriosis (DIE) represents the most severe form of the disease, often involving the posterior pelvic compartment and bowel, and is associated with significant morbidity. Transvaginal ultrasonography (TVUS) is the first-line imaging modality for suspected endometriosis. While bowel preparation improves the detection of posterior DIE, TVUS performed without bowel preparation remains widely used in daily practice and may provide clinically relevant information when applied using a structured and dynamic approach.\nFindings and procedure details\nIndications for US without bowel preparation\nFirst-line assessment\nTVUS without bowel preparation is widely available and feasible in routine outpatient settings. It´s common performed for initial evaluation of patients with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility (Figures 1-18)\nOvarian endometriomas\nTypical ultrasonographic features:\nHomogeneous low-level internal echoes (“ground-glass” appearance)\nThick cyst walls\nAbsence of solid vascular papillary projections\nAnterior compartment involvement\nTVUS without bowel preparation performs well for bladder endometriosis, vesicouterine pouch disease, and ureteral involvement (Figure 10).\nPosterior compartment screening\nTVUS without bowel...\nConclusion\nTransvaginal ultrasonography performed without bowel preparation remains a valuable first-line and triage imaging tool in patients with suspected endometriosis. When conducted using a structured, compartment-based and dynamic approach, it allows reliable detection of ovarian endometriomas, anterior compartment disease, and indirect signs of posterior deep endometriosis. Although sensitivity is reduced for small or multifocal bowel lesions, findings from a well-performed examination guide appropriate patient stratification, selection of complementary imaging, and referral to specialized centers, supporting efficient and patient-centered diagnostic pathways.\nPersonal information and conflict of interest\nE. M. J. De Barros:\nNothing to disclose\nP. Takieddine:\nNothing to disclose\nA. Borges:\nNothing to disclose\nA. Carvalho Dias:\nNothing to disclose\nG. G. Cerri:\nNothing to disclose\nR. A. Garcia Jureidini:\nNothing to disclose\nJ. A. B. Araújo-Filho:\nNothing to disclose\nReferences\n1. Li JL, Yong-Hing CJ, Jessup J, Kielar AZ, Pang EHT. Endometriosis imaging in the community setting: implementation of the SRU consensus recommendations on routine pelvic US. Abdom Radiol (NY). 2025 Oct;50(10):4878-4885.2. Daniilidis A, Grigoriadis G, Dalakoura D, D'Alterio MN, Angioni S, Roman H. Transvaginal Ultrasound in the Diagnosis and Assessment of Endometriosis-An Overview: How, Why, and When. Diagnostics (Basel). 2022 Nov 23;12(12):2912.3. Condous G, Gerges B, Thomassin-Naggara I, et al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an...","source_license":"CC0","license_restricted":false}