EP10.10: The value of sliding sign in the prediction of pouch of Douglas obliteration in patients with posterior compartment endometriosis

To evaluate the value of transvaginal real-time ultrasound sliding sign in the prediction of POD obliteration. 61 women with clinical diagnosis of endometriosis were recruited. They had the following symptoms: (i) intermenstrual bleeding; (ii) non-cyclic chronic pelvic pain; (iii) dysmenorrhea; (iv) dyspareunia; (v) cyclic pain; (vii) infertility. In our department, left hand scanning was performed. The presence or absence of sliding sign was evaluated as follows: Gentle pressure was exerted against the cervix with the transvaginal probe to establish whether (i) the anterior rectum glided freely across the posterior wall of the cervix; (ii) whether the rectosigmoid colon glided freely across the posterior uterine fundus. When there is doubt whether the rectosigmoid colon glided freely over the posterior aspect of the upper uterus/ fundal region, the right hand of the sonographer was placed over the lower abdominal wall of the patient to move the uterus between the palpating hand and the transvaginal probe. When the sliding was observed as positive, the POD was recorded as not obliterated. Overall the accuracy and sensitivity for predicting POD obliteration in our study was 100%. Positive sliding sign was observed in 17 patients whilst 44 patients had negative sliding sign. Of the 44 patients with negative sliding sign, 5 of them were found to have partial POD obliteration whilst 39 had complete POD obliteration. These results were validated on operative findings. Our observations of the 17 patients whom we recorded as free of POD obliteration were also confirmed during surgery. The sliding sign is a useful observation in the prediction of POD obliteration in patients with posterior compartment endometriosis.