OP06.01: Transvaginal ultrasonography and pelvic adhesions in patients with cystic ovarian endometriosis

To evaluate the role of transvaginal ultrasonography in the detection of pelvic adhesions in women suspected to have endometriomas. Ninety-seven women who underwent surgery for cystic ovarian endometriosis were prospectively recruited. All patients underwent transvaginal ultrasonography before surgery and the presence of fixation of the ovary to the uterus was considered characteristic of presence of pelvic adhesions. Patients were classified as having tuboperitoneal abnormalities if evidence of fimbrial, peritubal and/or peri-ovarian adhesions was encountered during surgery. Seventy-two women had pelvic adhesions. The likelihood ratio for fixation of the ovary to the uterus was 7.12 (95% CI 1.86-27) and for a ‘normal’ ultrasound 0.47 (0.35–0.63). The pre-test probability of pelvic adhesions in our population of women with an endometrioma was 74%, and this probability raised to 95% (95% CI 84%–99%) when fixation of the ovary to the uterus was present. On the contrary, the probability of presence of pelvic adhesions fell to 57% (95% CI 50%–64%) when this ultrasonographic finding was absent. This approach improves the detection and the exclusion of adhesions in women with ultrasonographic suspicion of presence of endometrioma and may be useful in the selection of different therapeutical options, surgical or medical, but also in the selection of an appropriate surgeon with sufficient experience in performing difficult laparoscopy in case of suspicion of adhesions.