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Forniceal-Vaginal Deep Endometriosis

  • Stefano GuerrieroEmail author
  • Gil Cohen
  • Silvia Ajossa
  • Ornella Comparetto
  • Camilla Ronchetti
  • Bruno Piras
  • Alba Piras
  • Valerio Mais

Abstract

The forniceal-vaginal anatomical area is located in the recess at the vault of the vagina. Forniceal deep endometriosis (DE) is mainly located in the posterior part of the vaginal fornix but might involve also the lateral parts of the fornix [1]. The mean prevalence of vaginal DE is 17% [2], ranging from 4 to 39% [3, 4]. This wide range is probably due to the different classification systems used before the International Deep Endometriosis Analysis (IDEA) consensus [5].

Supplementary material

Video 10.1

Tenderness-guided evaluation of a forniceal nodule. (AVI 19616 kb)

Video 10.2

Tenderness-guided evaluation of a diabolo-like nodule. (AVI 11958 kb)

Video 10.3

A forniceal nodule evaluated without sonovaginography. (AVI 38005 kb)

Video 10.4

The same nodule evaluated using sonovaginography. (AVI 12545 kb)

References

  1. 1.
    Chapron C, Chopin N, Borghese B, Foulot H, Dousset B, Vacher-Lavenu MC, Vieira M, Hasan W, Bricou A. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod. 2006;21:1839–45.CrossRefGoogle Scholar
  2. 2.
    Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, Alcazar JL. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46:534–45.CrossRefGoogle Scholar
  3. 3.
    Vimercati A, Achilarre MT, Scardapane A, Lorusso F, Ceci O, Mangiatordi G, Angelelli G, Van Herendael B, Selvaggi L, Bettocchi S. Accuracy of transvaginal sonography and contrast-enhanced magnetic resonance-colonography for the presurgical staging of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40:592–603.CrossRefGoogle Scholar
  4. 4.
    Guerriero S, Ajossa S, Gerada M, Virgilio B, Angioni S, Melis GB. Diagnostic value of transvaginal ‘tenderness guided’ ultrasonography for the prediction of location of deep endometriosis. Hum Reprod. 2008;23:2452–7.CrossRefGoogle Scholar
  5. 5.
    Guerriero S, Condous G, Van Den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, Exacoustos C, Installè AJF, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa s, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48:318.CrossRefGoogle Scholar
  6. 6.
    Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991;55:759–65.CrossRefGoogle Scholar
  7. 7.
    Vercellini P, Frontino G, Pietropaolo G, Gattei U, Daguati R, Crosignani PG. Deep endometriosis: definition and clinical management. J Am Assoc Gynecol Laparosc. 2004;11:153–61.CrossRefGoogle Scholar
  8. 8.
    Anaf V, El Nakadi I, De Moor V, Chapron C, Pistofidis G, Noel JC. Increased nerve density in deep infiltrating endometriotic nodules. Gynecol Obstet Investig. 2011;71(2):112–7.CrossRefGoogle Scholar
  9. 9.
    Matsuzaki S, Houlle C, Botchorishvili R, Pouly JL, Mage G, Canis M. Excision of the posterior vaginal fornix is necessary to ensure complete resection of rectovaginal endometriotic nodules of more than 2 cm in size. Fertil Steril. 2009;91(4 Suppl):1314–5.CrossRefGoogle Scholar
  10. 10.
    Donnez J, Pirard C, Smets M, Jadoul P, Squifflet J. Surgical management of endometriosis. Best Pract Res Clin Obstet Gynaecol. 2004;18(2):329–48.CrossRefGoogle Scholar
  11. 11.
    Squifflet J, Feger C, Donnez J. Diagnosis and imaging of adenomyotic disease of the retroperitoneal space. Gynecol Obstet Investig. 2002;54:43–51.CrossRefGoogle Scholar
  12. 12.
    Del Frate C, Rossano Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006;26:1705–18.CrossRefGoogle Scholar
  13. 13.
    Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719–26.CrossRefGoogle Scholar
  14. 14.
    Chapron C, Fauconnier A, Dubuisson JB, Barakat H, Vieira M, Bréart G. Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease. Hum Reprod. 2003;18(4):760–6.CrossRefGoogle Scholar
  15. 15.
    Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril. 1996;65:299–304.CrossRefGoogle Scholar
  16. 16.
    Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016;(2).Google Scholar
  17. 17.
    Noventa M, Saccardi C, Litta P, Vitagliano A, D’Antona D, Abdulrahim B, Duncan A, Alexander-Sefre F, Aldrich CJ, Quaranta M, Gizzo S. Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertil Steril. 2015;104(2):366–83.CrossRefGoogle Scholar
  18. 18.
    Chapron C, Barakat H, Fritel X, Dubuisson JB, Breart G, Fauconnier A. Presurgical diagnosis of posterior deep infiltrating endometriosis based on a standardized questionnaire. Hum Reprod. 2005;20:507–13.CrossRefGoogle Scholar
  19. 19.
    Fedele L, Bianchi S, Carmignani L, Berlanda N, Fontana E, Frontino G. Evaluation of a new questionnaire for the presurgical diagnosis of bladder endometriosis. Hum Reprod. 2007;22:2698–701.CrossRefGoogle Scholar
  20. 20.
    Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, Thomas A, Singer CF, Keckstein J. Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2011;37(4):480–7.CrossRefGoogle Scholar
  21. 21.
    Guerriero S, Ajossa S, Gerada M, D’Aquila M, Piras B, Melis GB. “Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain. Fertil Steril. 2007;88(5):1293–7.CrossRefGoogle Scholar
  22. 22.
    Guerriero S, Saba L, Ajossa S, Peddes C, Angiolucci M, Perniciano M, Melis GB, Alcazar JL. Three-dimensional ultrasonography in the diagnosis of deep endometriosis. Hum Reprod. 2014;29:1189–98.CrossRefGoogle Scholar
  23. 23.
    Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79:1023–7.CrossRefGoogle Scholar
  24. 24.
    Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40:464–9.CrossRefGoogle Scholar
  25. 25.
    Reid S, Winder S, Condous G. Sonovaginography: redefining the concept of a “normal pelvis” on transvaginal ultrasound pre-laparoscopic intervention for suspected endometriosis. Aust J Ultrasound Med. 2011;14:21–4.CrossRefGoogle Scholar
  26. 26.
    Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, Chou D, Almashat D, Condous G. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol. 2014;44:710–8.CrossRefGoogle Scholar
  27. 27.
    Leon M, Vaccaro H, Alcazar JL, Martinez J, Gutierrez J, Amor F, Iturra A, Sovino H. Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results. J Ultrasound Med. 2014;33:315–21.CrossRefGoogle Scholar
  28. 28.
    Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, Rodriguez I. Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography. Fertil Steril. 2010;94:2761–5.CrossRefGoogle Scholar
  29. 29.
    Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, Rodriguez I. Three-dimensional sonography for diagnosis of rectovaginal septum endometriosis: interobserver agreement. J Ultrasound Med. 2013;32:931–5.CrossRefGoogle Scholar
  30. 30.
    Millischer AE, Salomon LJ, Santulli P, Borghese B, Dousset B, Chapron C. Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results. Ultrasound Obstet Gynecol. 2015;46(1):109–17.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Stefano Guerriero
    • 1
    Email author
  • Gil Cohen
    • 2
  • Silvia Ajossa
    • 1
  • Ornella Comparetto
    • 1
  • Camilla Ronchetti
    • 1
  • Bruno Piras
    • 1
  • Alba Piras
    • 1
  • Valerio Mais
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity of Cagliari, Policlinico Universitario Duilio CasulaCagliariItaly
  2. 2.Department of Obstetrics and Gynecology, Ultrasound UnitBnai-Zion Medical CenterHaifaIsrael

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