Rectosigmoid endometriosis: Diagnostic tools – improving pre-operative information to women and the clinician

Bowel endometriosis are benign lesions, mainly located on the rectosigmoid colon, due to inflammation and fibrosis caused by endometriosis. Five to 12% of women with endometriosis may have bowel endometriosis and can suffer from pelvic pain and gastrointestinal symptoms during menstruation. Surgical treatment may be warranted with risk of complications like anastomotic leakage, rectovaginal fistula, bowel stenosis and risk of a temporary stoma. \nThe aim of the thesis is to improve diagnosis and information to women with symptomatic endometriosis before bowel surgery and the surgical team to optimize treatment. Currently, there are no standardized methods to measure the distance between the bowel lesion to the anal verge (LAVD) and size of the bowel lesion. These two parameters are important in planning surgery and to assess complication risks. We propose standardizing measurements and investigated two diagnostic tools, namely transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) to measure LAVD and TVS to assess lesion size. We found that TVS has limited reproducibility for LAVD compared to reference standard. Surprisingly, MRI was not superior to TVS when measuring LAVD. TVS has good reproducibility for measuring lesion size. \nOur research highlights the need to improve information to women requiring surgery and to our multi-disciplinary surgical team using non-invasive diagnostic tools.