Advertisement

Endometriomas and Pelvic Endometriosis

  • Shannon Reid
  • George CondousEmail author
Chapter

Abstract

Endometriosis affects between 6 and 10 % of women in the reproductive age range, and this frequency rises to 35–50 % for women who also experience pain and/or infertility. Although it is not possible to detect peritoneal endometriosis with imaging, transvaginal sonography (TVS) has been demonstrated to have a high accuracy for the diagnosis of ovarian endometrioma, deep infiltrating endometriosis (DIE) of the bowel and pelvic adhesions. Endometriomas are associated with subfertility, particularly if pelvic DIE is also present. In addition, endometriomas appear to be strongly associated with ovarian fixation and pouch of Douglas (POD) obliteration. Pelvic adhesions are important to identify preoperatively, as POD obliteration is associated with a threefold increase in the risk of bowel DIE and bowel surgery. POD obliteration may be diagnosed preoperatively using the dynamic, real-time TVS uterine ‘sliding sign’. Women with a negative sliding sign (i.e. POD obliteration) should be referred to an advanced laparoscopic surgeon and/or colorectal surgeon due to their high risk of complex adhesions and bowel DIE. With regard to the TVS diagnosis of pelvic DIE, a recent meta-analysis indicated that TVS and enhanced TVS techniques are highly accurate for the prediction of rectal/rectosigmoid DIE; however, the same does not hold true for other pelvic DIE locations (uterosacral ligaments, vagina, rectovaginal septum). A global consensus is needed regarding the criteria for the TVS diagnosis of the various locations of pelvic DIE, which would in turn allow for the development of a standardized specialized TVS assessment for women with pelvic pain and/or infertility.

Keywords

Uterosacral Ligament Posterior Vaginal Wall Rectovaginal Septum Pelvic Sidewall Pelvic Adhesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 7.1

(MP4 27398 kb)

Video 7.2

(MP4 10451 kb)

Video 7.3

(MP4 24131 kb)

Video 7.4

(MP4 5131 kb)

Video 7.5

(MP4 3875 kb)

Video 7.6

(MP4 9830 kb)

Video 7.7

(MP4 5321 kb)

Video 7.8

(MP4 8546 kb)

Video 7.9

(MP4 10908 kb)

Video 7.10

(MP4 53541 kb)

References

  1. 1.
    Giudice LC, Kao LC. Endometriosis. Lancet. 2004;364(9447):1789–99. Epub 2004/11/16.CrossRefPubMedGoogle Scholar
  2. 2.
    Opoien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, et al. In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril. 2012;97(4):912–8. Epub 2012/02/22.CrossRefPubMedGoogle Scholar
  3. 3.
    Reid S, Lu C, Condous G. Can we improve the prediction of pouch of Douglas obliteration in women with suspected endometriosis using ultrasound based models? A multicenter prospective observational study. Acta Obstet Gynecol Scand. 2015;94(12):1297–306.Google Scholar
  4. 4.
    Okaro E, Condous G, Khalid A, Timmerman D, Ameye L, Huffel SV, et al. The use of ultrasound-based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain – can we reduce the need for laparoscopy? BJOG. 2006;113(3):251–6. Epub 2006/02/21.CrossRefPubMedGoogle Scholar
  5. 5.
    Marasinghe JP, Senanayake H, Saravanabhava N, Arambepola C, Condous G, Greenwood P. History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries. J Obstet Gynaecol Res. 2014;40(3):785–90. Epub 2014/04/17.CrossRefPubMedGoogle Scholar
  6. 6.
    Ulukus M, Yeniel AO, Ergenoglu AM, Mermer T. Right endometrioma is related with more extensive obliteration of the Douglas pouch. Arch Gynecol Obstet. 2012;285(5):1483–6. Epub 2011/12/27.CrossRefPubMedGoogle Scholar
  7. 7.
    Gerges B LC, Reid S, Menakaya U, Nadim B, Condous G. “Soft marker” evaluation of ovarian mobility in the normal and endometriotic ovary. Ultrasound Obstet Gynecol. 2015. doi: 10.1002/uog.15990
  8. 8.
    Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, et al. Diagnostic accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the recto-sigmoid: a meta-analysis. Ultrasound Obstet Gynecol. 2015. Epub 2015/07/28.Google Scholar
  9. 9.
    Tammaa A, Fritzer N, Strunk G, Krell A, Salzer H, Hudelist G. Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum. Hum Reprod. 2014;29(6):1199–204. Epub 2014/04/30.CrossRefPubMedGoogle Scholar
  10. 10.
    Khong SY, Bignardi T, Luscombe G, Lam A. Is pouch of Douglas obliteration a marker of bowel endometriosis? J Minim Invasive Gynecol. 2011;18(3):333–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Reid S, Lu C, Casikar I, Reid G, Abbott J, Cario G, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41(6):685–91. Epub 2012/09/25.CrossRefPubMedGoogle Scholar
  12. 12.
    Leon M, Vaccaro H, Alcazar JL, Martinez J, Gutierrez J, Amor F, et al. Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results. J Ultrasound Med. 2014;33(2):315–21. Epub 2014/01/23.CrossRefPubMedGoogle Scholar
  13. 13.
    Reid S, Lu C, Casikar I, Mein B, Magotti R, Ludlow J, et al. The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound ‘sliding sign’ technique: inter- and intra-observer reproducibility. Hum Reprod. 2013;28(5):1237–46. Epub 2013/03/14.CrossRefPubMedGoogle Scholar
  14. 14.
    Menakaya U, Infante F, Lu C, Phua C, Model A, Messyne F, et al. Interpreting the real-time dynamic ‘sliding sign’ and predicting POD obliteration: an inter-, intra-observer, diagnostic accuracy and learning curve study. Ultrasound Obstet Gynecol. 2015. Epub 2015/07/28.Google Scholar
  15. 15.
    Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, et al. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol. 2014;44(6):710–8. Epub 2014/05/28.CrossRefPubMedGoogle Scholar
  16. 16.
    Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35(6):730–40. Epub 2010/05/27.PubMedGoogle Scholar
  17. 17.
    Guerriero S, Ajossa S, Mais V, Risalvato A, Lai MP, Melis GB. The diagnosis of endometriomas using colour Doppler energy imaging. Hum Reprod. 1998;13(6):1691–5. Epub 1998/08/04.CrossRefPubMedGoogle Scholar
  18. 18.
    Poder L, Coakley FV, Rabban JT, Goldstein RB, Aziz S, Chen LM. Decidualized endometrioma during pregnancy: recognizing an imaging mimic of ovarian malignancy. J Comput Assist Tomogr. 2008;32(4):555–8. Epub 2008/07/31.CrossRefPubMedGoogle Scholar
  19. 19.
    Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2014;28(5):655–81. Epub 2014/05/28.CrossRefPubMedGoogle Scholar
  20. 20.
    Menakaya UaC G. The retroverted uterus: refining the description of the real time dynamic ‘sliding sign’. Australasian J Ultrasound Med. 2013;16(3):1.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.University of SydneySydneyAustralia
  2. 2.Acute Gynaecology, Early Pregnancy and Advanced Endosurgery UnitNepean Hospital, Sydney Medical School Nepean, University of SydneySydneyAustralia

Personalised recommendations