VP62.40: Abdominal scan of endometriosis patients who are not sexually active

Endometriosis affects 10–15% of all women at reproductive age and, in some of them, symptoms may begin as early as at menarche. Endometriosis targeted pelvic scan is done transvaginally in most patients. In patient who are not sexually active we are confined to abdominal scan which is less sensitive for deep infiltrating endometriosis. In selected cases transrectal scan is used. Ovarian endometriosis is usually well demonstrated transabdominally, and findings of “kissing ovaries” behind the uterus in the Douglas pouch might raise suspicion of endometriosis. Here we present imaging of pelvic anterior and posterior compartment in search of deep infiltrating endometriosis and sliding sign using the transabdominal approach. In most of our cases it is possible to visualise most of the pelvic anterior compartment transabdominally; the urinary bladder, distal 2–3cm of the ureters before entering the bladder and the upper 4–5cm of the vagina demonstrated behind the bladder. In most of our patients it was possible to visualise a section of rectal anterior wall muscularis propria layer behind the vagina and part of the rectovagina septum in this area between the vagina and the rectum. In selected cases we are able to demonstrate proximal rectal foci, usually when the foci are high and fixed to the body of the uterus and not retrocervical. Ruling out pelvic adhesions with the use of positive “sliding sign” is difficult to achieve using transabdominal approach. It can sometimes be achieved by applying external pressure on the uterus, by valsalva manoeuvre done by the patient and by demonstration of spontaneous intestinal peristalsis around the uterus. Positive sliding sign of the ovaries is seldom acheived. In conclusion transabdominal scan of suspected endometriosis is limited and in many cases insufficient for presurgical assessment but, in most cases, some anterior and posterior compartment structures assessment and dynamic examination features can be achieved.