OC13.02: Ultrasound in the detection of rectal- and distal sigmoid involvement of deep endometriosis

Accurate prediction of the extent of distal bowel involvement in case of deep endometriosis could help in the planning of surgery: if the endometriotic lesion does superficially (only serosa) involve the bowel wall, conventional operative (LASER) laparoscopy will suffice, whereas deep infiltrating endometriosis into the muscularis necessitates bowel resection. The aim of this study was to evaluate the accuracy of ultrasound in the prediction of deep infiltrating endometriosis in the wall of the distal bowel. Retrospective observational study in 72 patients who had a bowel resection in a period of 51 months (from 13/9/2004 till 05/12/2008) and had a preoperative ultrasound examination performed by a single expert ultrasonographer (DT) prior to bowel resection for presumed deep infiltrating endometriosis. The records of the preoperative ultrasound examination as to the presence of deep endometriosis nodes in the rectal- and/or distal sigmoid wall (recorded as “yes”, “possible” or “no”) are compared with the histology report. Mean patients' age was 31.1 years (range 20–43). At ultrasound examination deep nodes were recorded at “yes”, “possible” and “no” in 51 (70.8%), 6 (8.3%) and 15 (20.8%) of cases. The histology of the resected bowel reported deep nodes in 51 (87.5%) cases. The positive predictive value of ultrasound in the detection of deep nodes was 89.4% (if “yes” and “possible” were considered “abnormal”) with a sensitivity of 79.4%. Ultrasound examination by a dedicated examiner is accurate in the detection of deep endometriotic nodes of the rectum- and/or distal sigmoid wall. The use of more specific ultrasound markers could improve these results.