Value of virtual colonoscopy in the prediction of surgical management of patients with rectal endometriosis.

Colonography CT, CT, Genital / Reproductive system female, Gastrointestinal tract, Obstruction / Occlusion Authors: C. Da Costa1, H. Roman1, J. van der Wat2, M. Vassilief1, J.-J. Tuech1, C. Martin1, J.-N. Dacher1, C. Savoye-Collet1; 1Rouen/FR, 2Johannesburg/ZA DOI: 10.1594/ecr2013/C-1008 Purpose Deep pelvic endometriosis is a chronic and disabling disease, which affects young premenopausal active women. Intestinal location of endometriosis mainly affects the rectum or the sigmoid colon [1] and is regarded as one of the most severe form of the disease. Two surgical techniques are currently available to treat intestinal involvements according to the severity of the lesions: radical intestinal resection or conservative surgery with simple nodule excision. For teams performing first-line conservative surgery, preoperative evaluation of the degree of intestinal stenosis is essential to...

and Materials Study design All 60 patients operated for rectal endometriosis and undergoing preoperative VC between 2009-2012 were included. Patients’ characteristics,

of VC and operative characteristics were retrospectively analyzed. VC preparation and technique The day before the examination, all patients received a light colonic preparation with dihydrate disodium phosphate based laxative solution (Normacol â) to ensure adequate cleansing. The examination started with limited pressure carbon dioxide insufflation after introduction of a flexible bulb catheter connected to an automated CO2 colon insufflator (E-Z-EM PROTOCO2L Colon Insufflator, Bracco...

All patients underwent surgery in the University Hospital of Rouen. Laparoscopy was undertaken in all 60 patients and successfully perfomed in 55 (92.7%). Five (8.3%) patients required conversion, because of difficulties of excision of the nodule (n=3), or following vascular injury and ureteral injury in one case each. Radical resection was performed in 14 (23.3%) patients. Of the 46 (76.7%) patients undergoing conservative surgery, 33 (55%) and 13 (21.7%) underwent shaving and full-thickness excision (Figure 8). Thirty-two (53.3%) patients preoperatively displayed rectal narrowing including 11...

Virtual colonoscopy is of major interest for teams practicing first line conservative surgeryas it brings valuable information in the evaluation of the digestive wall of patients with rectal endometriosis and therefore allows anticipation of the surgical technique to be undertaken.

Daraï E, Bazot M, Rouzier R, Houry S, Dubernard G. Outcome of laparoscopic colorectal resection for endometriosis. Curr Opin Obstet Gynecol. 2007 Aug;19(4):308-13. van der Wat J, Kaplan MD. Modified virtual colonoscopy: a noninvasive technique for the diagnosis of rectovaginal septum and deep infiltrating pelvic endometriosis.J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):638-43. Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, Tuech JJ, Marpeau L, Roman H. Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of...