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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References
Farinon AM, Stroppa I, Chiarelli C. Therapy of colorectal endometriosis. Colo Proctology 1992;l4:230–4.
Blumenkrantz MU, Gallagher N, Bashoore RA. Retrograde menstruation in women undergoing chronic peritoneal dialysis. Obstet Gynecol 1981;57:667–70.
Bartosik D. Immunologie aspects of endometriosis. Sem Reprod Endocrinol 1985;3:329.
The American Fertility Society. Revised American Fertility Society classification of endometriosis. Fertil Steril 1985;43:630–5.
Koninckx PR, Martin DC. Surgical treatment of deeply infiltrating endometriosis. In: Shaw RW, ed. Endometriosis: current understanding and management. Oxford: Blackwell Science Ltd, 1995:264–81.
Chapron C, Dubuisson JB. Management of deep endometriosis. Ann N Y Acad Sci 2001;943:276–80.
Zwas FR, Lyon FR. Endometriosis: an important condition in clinical gastroenterology. Dig Dis Sci 1991;36:353–64.
Schröder J, Löhnert M, Doniec JM, Dohrmann P. Endoluminal ultrasound diagnosis and operative management of rectal endometriosis. Dis Colon Rectum 1997;40:6l4–7.
Roseau G, Dumontier I, Palazzo L,et al. Rectosigmoid endometriosis: endoscopie ultrasound features and clinical implications. Endoscopy 2000;32:525–30.
St Ville EW, Jafri SZ, Madrazo BL, Mezwa DG, Bree RL, Rosenberg BF. Endorectal sonography in the evolution of rectal and perirectal disease. AJR Am J Roentgenol 1991;157:503–8.
Rösch T, Lorenz R, Classen M. Endoscopie ultrasonography in the evaluation of colon and rectal disease. Gastrointest Endosc 1990;36:S33–9.
Bazot M, Cortez A, Darai E,et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 2001;l6:2427–33.
Balleyguier C, Chapron C, Dubuisson JB,et al. Comparison of magnetic resonance imaging and transvaginal ultrasonography in diagnosing bladder endometriosis. J Am Assoc Gynecol Laparasc 2002;9:15–23.
Chapron C, Dumontier I, Dousset B,et al. Results and role of rectal endoscopie ultrasonography for patients with deep pelvic endometriosis. Hum Reprod 1998;13:2266–70.
Roseau G, Palazzo L, Cornier E,et al. Endometriose rectosigmoidienne: diagnostic par èchoendoscopie. Med Chir Dig 1993;22:20–2.
Graham B, Mazier WP. Diagnosis and management of endometriosis of the colon and rectum. Dis Colon Rectum 1988;31:952–6.
Athey PA, Diment DD. The spectrum of sonographic findings in endometriomas. J Ultrasound Med 1989;8:487–91.
Keane TE, Peel AL. Endometrioma: an intra-abdominal troublemaker. Dis Colon Rectum 1990;33:963–5.
Tran KT, Kuijpers HC, Willemsen WN, Buken H. Surgical treatment of symptomatic rectosigmoid endometriosis. Eur J Surg 1996;l62:139–4l.
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Supported by the Department for General and Thoracic Surgery. University of Kiel.
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Doniec, J.M., Kahlke, V., Peetz, F. et al. Rectal endometriosis: high sensitivity and specificity of endorectal ultrasound with an impact for the operative management. Dis Colon Rectum 46, 1667–1673 (2003). https://doi.org/10.1007/BF02660773
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DOI: https://doi.org/10.1007/BF02660773