OC11.03: Can we predict pouch of Douglas (POD) obliteration using a new real‐time ultrasound technique: the “sliding sign”

To evaluate transvaginal ultrasound (TVS) in predicting POD obliteration in women with chronic pelvic pain, prior to laparoscopic endometriosis surgery. Ongoing, multi-centre prospective observational study (June 2009–January 2011). All women included in this study were of reproductive age, had a history of chronic pelvic pain, and were planned for laparoscopic endometriosis surgery. A history was obtained and TVS was performed on all women prior to laparoscopy. The presence or absence of the “sliding sign” was recorded during real time ultrasound. The “sliding sign” is defined to be positive when the anterior rectal wall glides smoothly over the posterior vaginal wall and the anterior recto-sigmoid glides smoothly over the posterior fundus of the uterus. Women then underwent laparoscopic surgery for diagnosis and if necessary, surgical treatment of endometriosis. The correlation between TVS findings (“sliding sign”) and gold standard laparoscopic findings (POD obliteration) was then analyzed to assess the ability of TVS to predict obliteration of the POD prior to surgery. To date, complete TVS and laparoscopic data were available for 44 women. For predicting POD obliteration, the sensitivity and specificity of SVG were 90% and 94.1%, respectively. The PPV and NPV were 81.8% and 97%, respectively. Although the numbers are small, this ongoing study demonstrates that TVS can predict POD obliteration. This new “sliding sign” has the potential to aid in selecting women for specialist advanced laparoscopic intervention and in turn potentially reduce the need to two laparoscopies.