EP10.11: Transvaginal ultrasound in the evaluation of deep infiltrating endometriosis

To assess the accuracy of transvaginal ultrasound in the evaluation of deep infiltrating endometriosis. 45 women with clinical diagnosis of DIE were recruited. They had the following symptoms: (i) intermenstrual bleeding; (ii) non-cyclic pelvic pain; (iii) dysmenorrhea; (iv) dyspareunia; (v) painful defecation; (vi) cyclic pain; (vii) infertility. They were all scanned by a single sonographer. Transvaginal ultrasound of the uterus, ovaries, adnexal regions, uterosacral ligaments as well the surrounding bowels were assessed. Observations included: (i) mobility of the uterus including anteversion or retroversion, as well as the presence of abnormalities; (ii) mobility of ovaries and the presence of abnormalities; (iii) obliteration of Pouch of Douglas; (iv) thickening in the uterosacral ligaments and presence of nodules; (v) presence of nodules in bowels. Our findings included POD obliteration (15 cases), Bowel nodules (5 cases) and uterosacral nodules (29 cases). In this study we also encountered difficulties in evaluating DIE when there are presence of large masses, e.g. leiomyomata and ovarian cysts. Operative findings revealed a 100% sensitivity in the prediction of POD obliteration; 11 patients were found to have bowel nodules and 20 patients harboured uterosacral nodules. This is a small study in which we recruited 45 women. The sliding sign which we utilised for the prediction of POD obliteration has proven to be a very reliable technique. As for the evaluation of DIE involving bowels and uterosacral ligaments, ultrasound visualisation may be restricted by the presence of other large gynecological masses such as leiomyomata and cysts.