Does transvaginal ultrasonography combined with water-contrast in the rectum aid in the diagnosis of rectovaginal endometriosis infiltrating the bowel?

Mario Valenzano Menada, M Valenzano Menada, Valenzano Menada M, Valentino Remorgida, V. Remorgida, Abbamonte LH, L H Abbamonte, Luiza Helena Abbamonte, Nicoletti A, A Nicoletti, Amy Nicoletti, Nicola Ragni, N. Ragni, Ragni N, S Ferrero, Simone Ferrero
Human Reproduction · 2008 · vol. 23(5) , pp. 1069–1075 · doi:10.1093/humrep/den057 · PMID:18310049 · W2160572811
article OA: bronze CC0 ⤵ 94 in-corpus citations
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Rectal water-contrast transvaginal ultrasonography improved diagnosis of deep rectovaginal endometriosis infiltration compared to standard transvaginal ultrasonography, especially for muscularis propria involvement.

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Abstract

BACKGROUND: The aim of this study was to determine whether adding water-contrast in the rectum during transvaginal ultrasonography (RWC-TVS) improves the diagnosis of rectal infiltration in women with rectovaginal endometriosis. METHODS: This prospective study included 90 women, with suspect rectovaginal endometriosis, who underwent operative laparoscopy. TVS and RWC-TVS were independently performed by different investigators. RWC-TVS was performed by injecting saline solution into the rectal lumen under ultrasonographic control through a 6-mm catheter. Presence of rectovaginal nodules, presence and degree of rectal infiltration, and the largest diameter of the bowel nodules were evaluated. Ultrasonographic results were compared to surgical and histological findings. RESULTS: Although RWC-TVS had higher accuracy than TVS in diagnosing rectovaginal endometriosis, the difference between the two techniques was not statistically significant. RWC-TVS was significantly more accurate than TVS in determining the presence of endometriotic infiltration reaching at least the muscular layer of the rectal wall. The sensitivity of RWC-TVS in identifying rectal lesions was 97%, the specificity 100%, the positive predictive value 100% and the negative predictive value 91.3%. RWC-TVS caused a higher intensity of pain than TVS. CONCLUSIONS: RWC-TVS determines the presence of rectovaginal nodules infiltrating the rectal muscularis propria more accurately than TVS; RWC-TVS could be used when TVS cannot exclude the presence of rectal infiltration.

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Condition tags

endometriosisbowel_endometriosis

MeSH descriptors

Contrast Media Endometriosis Rectal Diseases Vaginal Diseases Water Adolescent Adult Endometriosis Endometriosis Endometriosis Female Humans Pain Pain Predictive Value of Tests Prospective Studies Rectal Diseases Rectal Diseases Rectal Diseases Sensitivity and Specificity

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