OC19.04: Sonographic evaluation of posterior deep pelvic endometriosis: endovaginal‐, transrectal‐ and vaginosonography to assess the extension of the disease

To evaluate the accuracy of different sonographic approaches in the assessment of posterior site of deep endometriosis: pouch of Douglas, rectovaginal septum, uterosacral ligaments, vaginal wall, comparing sonographic findings with laparoscopy and/or MRI diagnosis. Thirty one patients with deep pelvic endometriosis underwent sonographic evaluation prior to laparoscopy. All patients underwent transvaginal (TVS) and transrectal (TRS) sonography and if necessary vaginosonography was associated to the transrectal examination. The latter is based on TRS combined with introduction of saline solution into the vagina in order to create an hypoechoic area that distend the vaginal wall and allows to evaluate infiltrating endometriod tissue. A mapping of the extension of the disease was performed during sonographic examination and laparoscopy. The mapping was based on a list of sites, which described the endometriotic/fibrotic infiltrating tissue in terms of presence or absence on different sites of the posterior pelvis. Of the 31 patients with posterior deep pelvic endometriosis, 20 were scheduled for surgery and 11 for MRI and medical treatment. A comparison between TVS, TRS, vaginosonography and laparoscopy or MRI was performed. The concordance rate in the diagnosis of endometriotic nodes of the pouch of Douglas and uterosacral ligaments was similar for TVS and TRS 90% and 91% respectively. Whereas the accuracy in the diagnosis of rectovaginal nodes, in particular for those infiltrating the rectal wall and vaginal fornix, is higher with TRS and vaginosonography (94%). TRS and vaginosonography may provide accurate informations about the presence and the extension of posterior deep endometriosis. In particular it improves the diagnosis of the infiltration of the rectal wall and vaginal fornix and could be useful in the management and counseling of these patients and to guide the surgeon's laparoscopic approach.