Endometriosis Findings on Transvaginal Ultrasound without Bowel Preparation: a StepwiseApproach

Genital / Reproductive system female, Ultrasound, Education, Education and training Authors: E. M. J. De Barros, P. Takieddine, A. Borges, A. Carvalho Dias, G. G. Cerri, R. A. Garcia Jureidini, J. A. B. Araújo-Filho DOI: 10.26044/ecr2026/C-15039 Learning objectives To highlight the role of transvaginal ultrasonography without bowel preparation in suspected endometriosis; To demonstrate structured and dynamic scanning strategies for disease detection; To identify limitations and indications for complementary imaging.

Endometriosis is a major cause of chronic pelvic pain and infertility. Deep infiltrative endometriosis (DIE) represents the most severe form of the disease, often involving the posterior pelvic compartment and bowel, and is associated with significant morbidity. Transvaginal ultrasonography (TVUS) is the first-line imaging modality for suspected endometriosis. While bowel preparation improves the detection of posterior DIE, TVUS performed without bowel preparation remains widely used in daily practice and may provide clinically relevant information when applied using a structured and dynamic approach. Findings and procedure details Indications for US without bowel preparation First-line assessment TVUS without bowel preparation is widely available and feasible in routine outpatient settings. It´s common performed for initial evaluation of patients with chronic pelvic pain, dysmenorrhea, dyspareunia and infertility (Figures 1-18) Ovarian endometriomas Typical ultrasonographic features: Homogeneous low-level internal echoes (“ground-glass” appearance) Thick cyst walls Absence of solid vascular papillary projections Anterior compartment involvement TVUS without bowel preparation performs well for bladder endometriosis, vesicouterine pouch disease, and ureteral involvement (Figure 10). Posterior compartment screening TVUS without bowel...

Transvaginal ultrasonography performed without bowel preparation remains a valuable first-line and triage imaging tool in patients with suspected endometriosis. When conducted using a structured, compartment-based and dynamic approach, it allows reliable detection of ovarian endometriomas, anterior compartment disease, and indirect signs of posterior deep endometriosis. Although sensitivity is reduced for small or multifocal bowel lesions, findings from a well-performed examination guide appropriate patient stratification, selection of complementary imaging, and referral to specialized centers, supporting efficient and patient-centered diagnostic pathways. Personal information and conflict of interest E. M. J. De Barros: Nothing to disclose P. Takieddine: Nothing to disclose A. Borges: Nothing to disclose A. Carvalho Dias: Nothing to disclose G. G. Cerri: Nothing to disclose R. A. Garcia Jureidini: Nothing to disclose J. A. B. Araújo-Filho: Nothing to disclose

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