EP27.12: Endometrioma – the tip of a pelvic disease: TVS findings associated with an ovarian endometriosis

To investigate whether or not an ovarian endometrioma is associated to other appearances of pelvic endometriosis such as adhesions and/or deep infiltrating endometriosis (DIE), thus in order to improve the management of patients with pelvic pain or infertility. This is an observational retrospective study on patients who underwent a transvaginal sonographic scan and showed an ovarian cyst with typical appearance of an endometrioma. Patients with previous pelvic surgery and without symptoms were excluded. Other associated sonographic sign of pelvic endometriosis such as adhesion, tubal pathology, adenomyosis and DIE were recorded. 226 symptomatic patients ≤ 40 years with at least an ovarian endometrioma with a diameter of ≥ 20 mm were included in this study. Mean age was 32.9 ± 4.9 yrs, mean endometriomas diameter was 35.5 ± 16.5 mm, Bilateral endometriomas were observed in 32 patients (14%). Of the 226 patients 41(18%) showed posterior rectal DIE and 92 (41%) a thickening of at least one uterosacral lignament (USL). 138 patients (61%) showed adhesions and 82 (36%) had myometrial signs of adenomyosis. Only 21 (9%) had a single isolated ovarian lesion with a mobile ovary and without any other ultrasound signs of pelvic endometriomas. Ovarian endometrioma is a marker for pelvic endometriosis and is rarely isolated. A high percentage of USL involvement has been observed. In a clinical context when there is an ovarian endometrioma an accurate TVS should investigate the extent of the disease to check for other endometriotic lesions in order to choose the most appropriate management to treat patient's pain and infertility not only considering the presence of the ovarian lesion.