Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound
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This study analyzed clinical data and transvaginal ultrasound findings in 25 patients with posterior cul-de-sac endometriosis, identifying characteristic hypoechoic, solid masses on the rectosigmoid.
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Abstract
OBJECTIVE: The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis. MATERIALS AND METHODS: A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies. RESULTS: All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five. CONCLUSION: Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.
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Cited by (18)
- ‘That's just the Ovary!’ and other cases of mistaken identity on CT of the female pelvis 2024
- Clinical Significance of a Pain Scoring System for Deep Endometriosis by Pelvic Examination: Pain Score 2023
- Infiltrating endometriosis: Diagnostic keys in abdominal ultrasonography 2021
- The “Speckle Sign” in the Diagnosis of Posterior Compartment Endometriosis 2021
- Endometriosis infiltrante: claves diagnósticas en la ecografía abdominal 2020
- ENDOMETRIOSIS:: EVALUACIÓN POR RESONANCIA MAGNÉTICA 2018
- Endometrioma subcutáneo en la pared abdominal. A propósito de un caso 2017
- Imaging modalities for the non-invasive diagnosis of endometriosis 2016
- Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta‐analysis 2015
- Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results 2015
- Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta‐analysis 2015
- Resonancia magnética de la endometriosis: Revisión pictográfica 2012
- Endométriose pelvienne profonde en IRM : quelles lésions ? Pour quel impact ? 2012
- MR Imaging of endometriosis: A pictorial review. 2012
- A importância da ultrassonografia na endometriose de septo retovaginal e do fundo de saco posterior [The importance of ultrasound in the rectovaginal septum and posterior cul-de-sac endometriosis] 2010
- Diagnostic accuracy of transvaginal ultrasound for non‐invasive diagnosis of bowel endometriosis: systematic review and meta‐analysis 2010
- Pelvic Pain Associated with a Coloproctologic Etiology 2010
- Surgical Management Options for Patients with Infertility and Endometriosis 2010
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