P18.01: Transvaginal diagnosis of endometrioma: how often are there other endometriosis pelvic lesions?

To investigate whether or not an ovarian endometrioma detected by ultrasound was associated with other appearances of pelvic endometriosis such as adhesions and/or deep infiltrating endometriosis (DIE) in order to improve the management of patients with pelvic pain or infertility. This is an observational retrospective study including a group of women (n=255) with at least an ovarian endometrioma (at least diameter of ≥ 20 mm) detected by transvaginal ultrasound (TVS). Patients with previous pelvic surgery and without symptoms were excluded. Other associated sonographic signs of pelvic endometriosis such as adhesions, tubal pathology, adenomyosis and DIE were recorded according to a detailed TVS mapping of pelvic endometriosis. Subsequently a group of women (n=50) underwent laparoscopic treatment and during surgery a complete endometriosis mapping was assessed. Mean age was 34.2 ± 6.6 years, mean endometriomas diameter was 40.0 ± 18.1mm, bilateral endometriomas were observed in 65patients (25.5%). Of the 255 patients 50 underwent laparoscopic surgery due to severe symptoms whereas 205 had indications to medical therapy or ART. At TVS 55 (21.5%) showed posterior rectal DIE and 93 (36.4%) a thickening of at least one uterosacral ligament. 186 patients (73%) showed adhesions and 134 (53%) showed ultrasonographic features of adenomyosis. Only 57 (22%) had a single isolated ovarian lesion with a mobile ovary and without any other ultrasound signs of pelvic endometrioma. No statistically significant differences were observed in the TVS mapping and histological confirmation. Ovarian endometrioma is a marker for pelvic endometriosis and is rarely isolated 44% patients with an endometrioma showed DIE. Adhesions and adenomyosis are associated to endometrioma in more than 50%. In a clinical context when there is an ovarian endometrioma an accurate TVS should investigate the extension of the disease to check for other endometriotic lesions in order to choose the most appropriate treatment to manage pain and infertility.