Rectal endometriosis: high sensitivity and specificity of endorectal ultrasound with an impact for the operative management

J Marek Doniec, Marek J. Doniec, Doniec JM, Kahlke V, Volker Kahlke, Peetz F, Frederik Peetz, Bodo Schniewind, Schniewind B, Christoph Mundhenke, Mundhenke C, Löhnert MS, Matthias S. Löhnert, Kremer B, Bernd Kremer
Diseases of the colon and rectum · 2003 · vol. 46(12) , pp. 1667–1673 · doi:10.1007/bf02660773 · PMID:14668593 · W1995387457
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Endorectal ultrasound demonstrated 97% sensitivity and specificity for detecting rectal wall involvement in endometriosis, impacting surgical management decisions.

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This study evaluated the diagnostic accuracy of endorectal ultrasound for detecting rectal wall involvement in patients with suspected or proven endometriosis. The researchers analyzed data from 85 females, comparing preoperative ultrasound results against intraoperative findings and histopathology in 65 surgical cases. The technique demonstrated a high sensitivity and specificity of 97 percent for identifying rectal infiltration, which significantly aided in planning operative management and resulted in substantial symptom reduction post-surgery. This paper is centrally about endometriosis — specifically the diagnostic imaging and surgical implications of deep infiltrating endometriosis affecting the rectum.

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Abstract

PURPOSE: In patients with histopathologically proven or suspected endometriosis with possible involvement of the rectum, endorectal ultrasound was performed to determine the sensitivity and specificity of this method with regard to rectal wall involvement and the impact on the following operation. METHODS: In an historical cohort analysis, 85 females with histopathologically proven or suspected endometriosis with possible involvement of the rectum were treated between 1992 and 2001. Endorectal ultrasound was performed with a 7.5 MHz real-time unit, and results of endorectal ultrasound were compared with intraoperative findings and histopathologic diagnosis of 65 patients undergoing operation. A questionnaire was used to evaluate postoperative signs and symptoms. RESULTS: Of 65 patients undergoing surgery, 37 underwent laparotomy with 25 resections of the bowel and 28 laparoscopy. In 31 of 32 patients with suspected rectal wall infiltration, preoperative endorectal ultrasound diagnosis was confirmed. In patients in whom endorectal ultrasound showed no rectal wall involvement, histopathology revealed infiltration in one patient, leading to sensitivity of 97 percent and specificity of 97 percent with regard to rectal wall involvement. In terms of the deepness of rectal wall infiltration, endorectal ultrasound had a sensitivity of 76 percent with regard to infiltration of the muscularis propria and 66 percent for infiltration of the submucosa. Operations led to a significant (P < 0.05) reduction of preoperative symptoms by approximately 60 percent. CONCLUSIONS: Endorectal ultrasound is a useful, noninvasive technique for preoperative evaluation of possible rectal wall involvement in endometriosis. Based on the high sensitivity and specificity, recommendation for laparotomy and bowel resection in cases with suspected rectal involvement can be facilitated.
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Methods

In an historical cohort analysis, 85 females with histopathologically proven or suspected endometriosis with possible involvement of the rectum were treated between 1992 and 2001. Endorectal ultrasound was performed with a 7.5 MHz real-time unit, and results of endorectal ultrasound were compared with intraoperative findings and histopathologic diagnosis of 65 patients undergoing operation. A questionnaire was used to evaluate postoperative signs and symptoms.

Results

Of 65 patients undergoing surgery, 37 underwent laparotomy with 25 resections of the bowel and 28 laparoscopy. In 31 of 32 patients with suspected rectal wall infiltration, preoperative endorectal ultrasound diagnosis was confirmed. In patients in whom endorectal ultrasound showed no rectal wall involvement, histopathology revealed infiltration in one patient, leading to sensitivity of 97 percent and specificity of 97 percent with regard to rectal wall involvement. In terms of the deepness of rectal wall infiltration, endorectal ultrasound had a sensitivity of 76 percent with regard to infiltration of the muscularis propria and 66 percent for infiltration of the submucosa. Operations led to a significant (P< 0.05) reduction of preoperative symptoms by approximately 60 percent.

Conclusions

Endorectal ultrasound is a useful, noninvasive technique for preoperative evaluation of possible rectal wall involvement in endometriosis. Based on the high sensitivity and specificity, recommendation for laparotomy and bowel resection in cases with suspected rectal involvement can be facilitated.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Laparoscopy Rectal Diseases Rectal Diseases Rectum Adult Cohort Studies Endometriosis Female Humans Laparotomy Middle Aged Patient Care Planning Rectal Diseases Rectum Retrospective Studies Sensitivity and Specificity Severity of Illness Index Ultrasonography

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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