Rectosigmoid Endometriosis: Endoscopic Ultrasound Features and Clinical Implications

Roseau G, G Roseau, Roseau, Dumontier I, I. Dumontier, Dumontier, Palazzo L, Palazzo, L. Palazzo, C. Chapron, Chapron C, Chapron, B. Dousset, S Chaussade, Chaussade, Chaussade S, Dubuisson JB, Dubuisson, J B Dubuisson, Couturier, Couturier D, D Couturier
Endoscopy · 2000 · vol. 32(7) , pp. 525–530 · doi:10.1055/s-2000-9008 · PMID:10917184 · W2052539678
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

Endoscopic ultrasound correctly diagnosed rectal wall infiltration in deep pelvic endometriosis, proving superior to other imaging methods and aiding surgical approach decisions.

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This retrospective study evaluated whether rectal endoscopic ultrasonography (EUS) can characterize rectosigmoid involvement in deep pelvic endometriosis and support surgical planning. Forty-six women with deep pelvic endometriosis underwent clinical and imaging assessment followed by EUS, with surgical resection (therapeutic laparoscopy or laparotomy) and histologic confirmation; the authors compared EUS findings with suspected rectal wall infiltration. EUS stratified patients as having normal rectosigmoid anatomy (9), endometriotic lesions without rectal wall infiltration (12), or typical rectal wall infiltration (25), and infiltration identified by EUS was initially suspected by other tests only in a minority of cases (e.g., 33–67% depending on modality), with confirmation by surgery and clinical follow-up. The paper does not present a detailed explicit limitation beyond its retrospective design and reliance on outcomes available through surgical/clinical confirmation, and it focuses on preoperative imaging associations to guide resection approach. This paper is centrally about endometriosis — specifically diagnosing rectosigmoid deep infiltrating endometriosis with EUS to assess rectal wall infiltration and inform whether laparoscopy versus laparotomy is used.

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Abstract

BACKGROUND AND STUDY AIMS: The main area of the gastrointestinal tract affected by deep pelvic endometriosis is the rectosigmoid colon in 3-37% of cases. Due to the risk of infiltration and the clinical symptoms of endometriosis, with pain and infertility, the condition may require surgical resection. Preoperative imaging diagnosis of rectosigmoid involvement is therefore important. Rectal endoscopic ultrasonography (EUS), which is already used for the staging of anorectal carcinoma and submucosal lesions, may be a promising technique for this indication. The present study was conducted in order to describe the endosonographic appearance of rectosigmoid endometriosis, and to define the potential relevance of the technique to the choice of resection method. PATIENTS AND METHODS: Between 1993 and 1997, 46 women (mean age 31) with deep pelvic endometriosis underwent imaging investigations and surgical resection. The clinical and imaging findings, and the surgical and histological features identified--mainly with regard to infiltration of the rectal wall--were compared retrospectively. The impact of the EUS findings on the decision on whether or not to carry out resection, either by laparoscopy or open abdominal surgery, was also examined. RESULTS: When there was deep pelvic endometriosis with suspected rectal wall infiltration, EUS showed normal anatomy in nine patients, endometriotic lesions without rectal wall infiltration in 12, and typical rectal infiltration in 25. The lesions were confirmed by the surgical findings during therapeutic laparoscopy (n = 22) and laparotomy (n = 25), as well as by clinical follow-up. Rectal wall infiltration, demonstrated in all cases using EUS, had initially been suspected on the basis of clinical examinations, rectoscopy, barium enema, computed tomography, and magnetic resonance imaging in 62%, 50%, 33%, 67% and 66% of cases, respectively. CONCLUSIONS: EUS is a simple and noninvasive technique capable of correctly diagnosing rectal wall infiltration in deep pelvic endometriosis. It may be helpful in determining the choice between laparoscopy and laparotomy when complete resection is indicated.
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Background

and Study Aims: The main area of the gastrointestinal tract affected by deep pelvic endometriosis is the rectosigmoid colon in 3 - 37 % of cases. Due to the risk of infiltration and the clinical symptoms of endometriosis, with pain and infertility, the condition may require surgical resection. Preoperative imaging diagnosis of rectosigmoid involvement is therefore important. Rectal endoscopic ultrasonography (EUS), which is already used for the staging of anorectal carcinoma and submucosal lesions, may be a promising technique for this indication. The present study was conducted in order to describe the endosonographic appearance of rectosigmoid endometriosis, and to define the potential relevance of the technique to the choice of resection method. Patients and Methods: Between 1993 and 1997, 46 women (mean age 31) with deep pelvic endometriosis underwent imaging investigations and surgical resection. The clinical and imaging findings, and the surgical and histological features identified - mainly with regard to infiltration of the rectal wall - were compared retrospectively. The impact of the EUS findings on the decision on whether or not to carry out resection, either by laparoscopy or open abdominal surgery, was also examined.

Results

When there was deep pelvic endometriosis with suspected rectal wall infiltration, EUS showed normal anatomy in nine patients, endometriotic lesions without rectal wall infiltration in 12, and typical rectal infiltration in 25. The lesions were confirmed by the surgical findings during therapeutic laparoscopy (n = 22) and laparotomy (n = 25), as well as by clinical follow-up. Rectal wall infiltration, demonstrated in all cases using EUS, had initially been suspected on the basis of clinical examinations, rectoscopy, barium enema, computed tomography, and magnetic resonance imaging in 62 %, 50 %, 33 %, 67 % and 66 % of cases, respectively.

Conclusions

EUS is a simple and noninvasive technique capable of correctly diagnosing rectal wall infiltration in deep pelvic endometriosis. It may be helpful in determining the choice between laparoscopy and laparotomy when complete resection is indicated.

Abstract

in French:Léndomåtriose pelvienne profonde peut atteindre le rectosigmoide dans à 37 % des cas. L'importance de l'infiltration et de la symptomatologie clinique, douleurs et stérilité, justifient souvent un traitement chirurgical. Il est alors important de rechercher une localisation digestive avant l'intervention. L'échoendoscopie rectale (EE), qui est déjà utilisée pour le bilan préthérapeutique des cancers du rectum et des tumeurs sous-muqueuses, pourrait être proposée dans cette indication. Les buts de cette étude étaient de décrire les aspects échoendoscopiques de l'endométriose rectosigmoidienne, et de préciser la place de cette technique dans le choix des méthodes de résection. Méthodes: De 1993 a 1997, 46 femmes atteintes d'une endométriose profonde (age moyen 31 ± 6 ans) ont été explorées par EE et opérées. Concernant l'infiltration rectosigmoidienne, des comparaisons rétrospectives ont été faites entre les signes cliniques, échographiques et les constations opératoires. L'impact de l'EE sur le choix de la méthode de résection par laparotomie ou coelioscopie a été également évalué. Résultats: En fonction des constatations échoendoscopiques, les malades se répartissaient en 9 cas ayant une anatomie normale, 12 ayant des images d'endométriose pelvienne sans atteinte des parois rectosigmoidiennes, et 25 autres avec une infiltration digestive caractérisée. Ces anomalies anatomiques ont été confirmées par les constatations opératoires (22 malades laparotomisées et 25 traitées par coeliosopie), et par le suivi clinique. L'infiltration rectale démontrée par l'EUS dans tous les cas, avait été suspectée cliniquement chez 62 % des patients, et dans 50 %, 33 %, 67 % et 66 % des cas par les autres examens: rectoscopie, lavement baryté, scanner et imagerie par résonance magnétique.

Conclusions

L'EE est une méthode simple et non invasive pour déceler une infiltration rectale dans l'endométriose profonde. Elle peut guider le choix entre une coelioscopie ou une laparotomie lorsqu'une résection est décidée.

References

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Endosonography Rectal Diseases Sigmoid Diseases Adult Endometriosis Endometriosis Female Humans Middle Aged Rectal Diseases Rectal Diseases Retrospective Studies Sensitivity and Specificity Sigmoid Diseases Sigmoid Diseases

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