P28.02: The association between symptoms and surgical findings in women with suspected endometriosis

To determine whether there is an association between specific symptoms and surgical findings in women with suspected endometriosis. Multi-center prospective observational study undertaken from January 2009 to February 2013. All women included in this study were of reproductive age, had a history of chronic pelvic pain and/or endometriosis, and had a plan for laparoscopic endometriosis surgery. A detailed history was obtained and the following surgical features were recorded during laparoscopy: uterine position, ovarian mobility, deep infiltrating endometriotic (DIE) nodules involving anterior rectum, rectosigmoid, pararectal space, pelvic sidewall, uterosacral ligaments (USL), rectovaginal septum (RVS) and/or vagina. The association between these various surgical findings and specific symptoms recorded during the history were analyzed for significance using Fisher's exact test. The following symptoms were significantly associated (p < 0.01) with the respective surgical findings: dyschezia - presence of any posterior compartment DIE, bowel surgery, left ovarian endometrioma; rectal bleeding - presence of any posterior compartment DIE, rectosigmoid DIE, bowel surgery, left and right ovarian fixation, and right ovarian endometrioma; tenesmus - presence of any posterior compartment DIE, right ovarian fixation; left iliac fossa pain - left and right ovarian fixation; right iliac fossa pain- rectovaginal septum DIE. This study helps to define the symptoms that may be significantly associated with disease location at laparoscopy in women with suspected endometriosis. In particular, women with dyschezia, rectal bleeding and/or tenesmus are at an increased risk of having posterior compartment DIE and should therefore undergo a detailed pre-operative TVS assessment for the mapping of posterior compartment DIE prior to surgery.