OP11.02: Symptomatic women with endometriosis: beyond the ovaries

Endometriosis is a common gynaecological disease predominantly found in women in reproductive age and typically causes pelvic pain and infertility. Ovaries are one of the common sites that endometriosis affects but different types of endometriosis such a deep endometriosis (DE) must be evaluated. The aim of the present study is to evaluate the application of three-dimensional introital ultrasound (3D IUS) in symptomatic women without ovarian endometrioma. We retrospectively evaluated the relationship between a group of 41 women suffering from pelvic pain and the anatomical features of pelvic endometriosis. All women underwent both B-mode and 3D IUS in order to evaluate ovary and DE. Patients were divided into three groups according to the type of endometriosis: 1) ovarian endometrioma; 2) deep endometriosis; 3) ovarian endometrioma associated with a DE lesion. All patients underwent surgery. Of these 41 patients, deep endometriosis without ovarian lesions was found in 6 (14.6%) cases by using 3D IUS and confirmed by surgery. Thirteen patients (31.7%) had an ovarian endometrioma no associated with the DE lesions. Of the remaining 22 patients (53.6%) a DE lesion was associated with an ovarian endometrioma and diagnosed by 3D IUS. Pain symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia are related to endometriotic implants at the posterior part of the pelvis or those with deep invasions. In symptomatic patients, deep endometriosis should be investigated in order to find DE lesions even if the absence of an ovarian endometrioma. Three-dimensional introital ultrasound should be considered as an important diagnostic technique in this group of women.