OP16.01: The use of the soft marker, site‐specific tenderness at TVS, in the pre‐operative mapping of peritoneal endometriosis

To determine whether the presence of site-specific tenderness during TVS corresponds with the location of peritoneal endometriosis at surgery for women with suspected endometriosis. Multi-centre prospective observational study undertaken from January 2009 to February 2013. This study included women with symptoms of chronic pelvic pain +/− history of endometriosis, planned for laparoscopic endometriosis surgery. All women underwent pre-operative TVS, where site-specific tenderness was elicited by placing gentle pressure with the TV probe against each of the six locations: anterior fornix, right adnexa, left adnexa, right uterosacral ligament (RUSL), left USL, and posterior fornix. Women rated their pain score from 0 (no pain) to 10 (worst pain) for each of the six locations. All women underwent laparoscopy +/− excision of endometriosis. Those women with either an endometrioma and/or posterior compartment deep infiltrating endometriosis at laparoscopy were excluded from the analysis, i.e. only those women with peritoneal disease were included. The relationship between site-specific tenderness at TVS and location of peritoneal endometriosis at surgery was then analysed. 189 consecutive women with TVS and laparoscopic outcomes were included in the final analysis. 100 women were found to have isolated peritoneal endometriosis. Peritoneal endometriosis was present in the following locations at surgery: left USL (39%), right USL (33%), left pelvic sidewall (30%), right pelvic sidewall (23%), pouch of Douglas (POD) (22%), uterovesical pouch (14%), left pararectal space (9%), right pararectal space (6%), and posterior cervix (4%). The only positive association between site-specific tenderness at TVS and peritoneal endometriosis location at surgery was for site-specific tenderness at the posterior vaginal fornix and the presence of peritoneal endometriosis in the POD (p = 0.0486). The use of site specific tenderness during TVS appears to be useful in the mapping of peritoneal endometriosis involving the POD.