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She Y, Sun S, Ge N. Diagnostic value of endoscopic ultrasound in pelvic masses with bowel involvement. Int J Surg 2024; 110:2085-2091. [PMID: 38668660 PMCID: PMC11019971 DOI: 10.1097/js9.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This study aimed to evaluate the effectiveness of EUS in predicting colorectal invasion in patients with pelvic masses and compare its accuracy with that of other imaging methods, namely pelvic MRI and abdominal computed tomography (CT), in predicting intestinal involvement in patients with histologically confirmed colorectal invasion. METHODS A hundred and eighty-four female patients with histologically confirmed benign or malignant pelvic masses were enrolled in a retrospective-prospective study. All patients underwent EUS, pelvic MRI, and one or more of abdominal CT, transvaginal sonography, and colonoscopy examinations before surgery. The surgical and pathological results were used as the gold standard to evaluate the diagnostic accuracy of EUS for colorectal invasion of pelvic masses. RESULTS This study included 184 patients who underwent surgery, with the time between EUS and surgery ranging from 1 to 309 (mean, 13.2) days. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of EUS for benign and malignant pelvic masses infiltrating the intestine were 83.3, 97.8, 99.1, and 66.2%, respectively. The overall diagnostic accuracy was 87.0%. CONCLUSIONS EUS is a simple, noninvasive, reliable, and accurate technique for the preoperative diagnosis of pelvic masses infiltrating the intestine. The authors recommend the use of this technology by gynecologists, as well as its incorporation into the preoperative diagnostic process to determine the most suitable surgical method. This would help in avoiding unexpected situations and unnecessary resource wastage during surgery.
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Affiliation(s)
| | | | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
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She YM, Ge N. Diagnostic value of endoscopic ultrasonography in pelvic masses with bowel involvement. Therap Adv Gastroenterol 2023; 16:17562848231163414. [PMID: 37153498 PMCID: PMC10161300 DOI: 10.1177/17562848231163414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/26/2023] [Indexed: 05/09/2023] Open
Abstract
Benign and malignant pelvic masses with or without intestinal invasion are common in women of childbearing age. Patients may have nonspecific symptoms and signs or experience no symptoms. Laparoscopic resection of pelvic masses is currently the mainstream treatment; therefore, accurate preoperative evaluation is not only essential for patients suspected of having intestinal invasion, but also extremely important for the selection of follow-up treatment. Procedures, including endoscopic ultrasonography (EUS), pelvic magnetic resonance imaging, abdominal computed tomography, vaginal ultrasonography, barium enema, and colonoscopy, aid in determining the presence, depth, and histology of the disease. In particular, the wide application and continuous developments in EUS techniques have improved the diagnostic accuracy for intestinal subepithelial and peripheral organ lesions. This article reviewed the clinical value of EUS in the diagnosis of benign and malignant pelvic masses with bowel involvement.
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Affiliation(s)
- Yu Mo She
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Rosefort A, Huchon C, Estrade S, Paternostre A, Bernard JP, Fauconnier A. Is training sufficient for ultrasound operators to diagnose deep infiltrating endometriosis and bowel involvement by transvaginal ultrasound? J Gynecol Obstet Hum Reprod 2018; 48:109-114. [PMID: 29654939 DOI: 10.1016/j.jogoh.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To assess and compare the diagnostic accuracy of transvaginal ultrasonography (TVUS) by trained or untrained ultrasound operators in deep infiltrating endometriosis (DIE) imaging, for diagnosing DIE and bowel involvement. METHODS This was an observational study of patients with clinically suspected DIE operated in a reference center. TVUS was performed pre-operatively by a trained or/and untrained ultrasound operator to search for DIE and rectal involvement. During surgery, DIE was diagnosed according to macroscopic and histological criteria. Sensitivity (Se), specificity (Sp) and c-index were calculated with 95% confidence intervals for trained and untrained operators, if TVUS results were significantly predictive of DIE and rectal involvement at p<0.05. RESULTS 115 patients were included: 100 (87%) had DIE and 34 (29.6%) had bowel involvement. TVUS was performed by a trained ultrasound operator for 70 patients and by an untrained one for 56 patients. When performed by a trained operator, TVUS significantly predicted DIE with a Se of 58% (95% CI, 46-70), a Sp of 87.5% (95% CI, 63-100) and a c-index of 0.73 (95% CI, 0.59-0.87). TVUS performed by an untrained operator was not significantly predictive of DIE (p=0.58). Rectal involvement was significantly predicted by TVUS performed by a trained operator with a Se of 40% (95% CI, 23-59), a Sp of 93% (95% CI, 86-100) and a c-index of 0.67 (95% CI, 0.56-0.77). None of the untrained ultrasound operators diagnosed a bowel involvement. CONCLUSION TVUS is not sufficient to diagnose DIE and bowel involvement, in particular when performed by untrained ultrasound operators.
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Affiliation(s)
- A Rosefort
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University Versailles Saint-Quentin en Yvelines, 78000 Versailles, France
| | - S Estrade
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France
| | - A Paternostre
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; European Center of Diagnosis and Exploration of the Woman, 78150 Le Chesnay, France
| | - J-P Bernard
- European Center of Diagnosis and Exploration of the Woman, 78150 Le Chesnay, France
| | - A Fauconnier
- Department of Gynaecology and Obstetrics, CHI Poissy-St-Germain, 78300 Poissy, France; Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", University Versailles Saint-Quentin en Yvelines, 78000 Versailles, France.
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Ferrero S, Morotti M, Menada MV, Venturini PL, Biscaldi E, Camerini G, Remorgida V. Diagnosis of Bowel Endometriosis: A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402651000200204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since the presence of intestinal endometriosis cannot be reliably established by physical examination or the evaluation of intestinal symptoms, imaging techniques are required for the diagnosis of bowel endometriosis. This review evaluates the techniques available for the diagnosis of intestinal endometriosis based on a search of the Medline database and Embase up to February 2010. Several studies have proved that radiological techniques (double contrast barium enema, magnetic resonance imaging, and multidetector computerized tomography enteroclysis) are able to accurately diagnose intestinal endometriosis. Magnetic resonance imaging has the advantage of determining the presence of deep endometriotic lesions in other pelvic locations. Rectal endoscopic ultrasonography can precisely determine the presence of bowel endometriosis but its use is limited by the availability of the equipment required to carry out the exam. Over the last five years, several studies have proved that transvaginal ultrasonography is accurate in the diagnosis of rectosigmoid endometriosis; in addition, this exam is well tolerated by patients and is inexpensive. Therefore, transvaginal ultrasonography should be the first-line investigation in patients with suspected intestinal endometriosis.
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Affiliation(s)
- Simone Ferrero
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa - Italy
| | - Matteo Morotti
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa - Italy
| | - Mario Valenzano Menada
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa - Italy
| | - Pier Luigi Venturini
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa - Italy
| | - Ennio Biscaldi
- Department of Radiology, Duchesse of Galliera Hospital, Genoa - Italy
| | - Giovanni Camerini
- Department of Surgery, San Martino Hospital and University of Genoa, Genoa - Italy
| | - Valentino Remorgida
- Department of Obstetrics and Gynecology, San Martino Hospital and University of Genoa, Genoa - Italy
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Gastrointestinal and Urinary Tract Endometriosis: A Review on the Commonest Locations of Extrapelvic Endometriosis. Adv Med 2018; 2018:3461209. [PMID: 30363647 PMCID: PMC6180923 DOI: 10.1155/2018/3461209] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Extrapelvic endometriosis is a rare entity that presents serious challenges to researchers and clinicians. Endometriotic lesions have been reported in every part of the female human body and in some instances in males. Organs that are close to the uterus are more often affected than distant locations. Extrapelvic endometriosis affects a slightly older population of women than pelvic endometriosis. This might lead to the assumption that it takes several years for pelvic endometriosis to "metastasize" outside the pelvis. All current theories of the pathophysiology of endometriosis apply to some extent to the different types of extrapelvic endometriosis. The gastrointestinal tract is the most common location of extrapelvic endometriosis with the urinary system being the second one. However, since sigmoid colon, rectum, and bladder are pelvic organs, extragenital pelvic endometriosis may be a more suitable definition for endometriotic implants related to these organs than extrapelvic endometriosis. The sigmoid colon is the most commonly involved, followed by the rectum, ileum, appendix, and caecum. Most lesions are confined in the serosal layer; however, deeper lesion can alter bowel function and cause symptoms. Bladder and ureteral involvement are the most common sites concerning the urinary system. Unfortunately, ureteral endometriosis is often asymptomatic leading to silent obstructive uropathy and renal failure. Surgical excision of the endometriotic tissue is the ideal treatment for all types of extrapelvic endometriosis. Adjunctive treatment might be useful in selected cases.
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Kim A, Fernandez P, Martin B, Palazzo L, Ribeiro-Parenti L, Walker F, Bucau M, Collinot H, Luton D, Koskas M. Magnetic Resonance Imaging Compared with Rectal Endoscopic Sonography for the Prediction of Infiltration Depth in Colorectal Endometriosis. J Minim Invasive Gynecol 2017; 24:1218-1226. [PMID: 28802956 DOI: 10.1016/j.jmig.2017.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE To compare the accuracies of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) in the prediction of the infiltration depth of colorectal endometriosis. DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING A university teaching hospital. PATIENTS Forty patients with symptomatic deep infiltrating endometriosis (DIE) of the rectum who underwent colorectal resection were included. INTERVENTIONS All patients underwent abdominopelvic MRI and RES preoperatively to assess the infiltration depth of colorectal endometriosis, and segmental resection of the rectosigmoid by laparoscopy was performed if RES showed bowel invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LRs), and intermethod agreement were calculated for DIE muscularis and submucosal/mucosal infiltration confirmed by histopathological analysis. MEASUREMENTS AND MAIN RESULTS For MRI detection of DIE muscularis infiltration, the sensitivity, specificity, PPV, NPV, and negative LR were 68%, 100%, 100%, 20%, and 0.32, respectively. For the MRI detection of DIE submucosal/mucosal involvement, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 47%, 81%, 69%, 63%, 2.49, and 0.65, respectively. The PPV of RES detection of DIE muscularis infiltration was 93%. For the RES detection of DIE submucosal/mucosal layers, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 79%, 48%, 58%, 71%, 1.51, and 0.44, respectively. CONCLUSION In the current study, MRI is valuable for detecting endometriosis of the rectum but is less accurate in detecting submucosal/mucosal involvement than RES. Magnetic resonance imaging was not successful for preoperative determination of segmental resection versus a more conservative approach. When bowel involvement is detected by MRI, RES is not essential. When symptoms suggest DIE in patients without intestinal lesions detected by MRI, RES is necessary to exclude bowel invasion.
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Affiliation(s)
- Arane Kim
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France.
| | | | | | | | | | | | - Margot Bucau
- Department of Pathology, Bichat Hospital, Paris, France
| | - Helene Collinot
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France
| | - Martin Koskas
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France; Paris Diderot University, Paris, France
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Abstract
Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers.
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Myung DS, Kim HR, Joo YE. [Colonic Endometriosis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 66:127-30. [PMID: 26513825 DOI: 10.4166/kjg.2015.66.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rossi L, Palazzo L, Yazbeck C, Walker F, Chis C, Luton D, Koskas M. Can rectal endoscopic sonography be used to predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:322-327. [PMID: 23754206 DOI: 10.1002/uog.12535] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 05/29/2013] [Accepted: 05/31/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of rectal endoscopic sonography (RES) in the prediction of the infiltration depth of rectal endometriosis and to ascertain whether RES could be used to choose between segmental bowel resection and a more conservative approach, such as shaving or discoid resection. METHODS In this retrospective study, 38 consecutive patients with symptomatic deep infiltrating endometriosis of the rectum who underwent laparoscopic colorectal resection were included. RES results for infiltration depth of rectal endometriosis were compared with results of pathological examination. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LRs) and test accuracy were calculated for the presence of infiltration of the muscularis layers and submucosal/mucosal layers, as demonstrated by RES and confirmed by histopathological analysis. RESULTS For the detection of muscularis layer infiltration by endometriosis, the PPV of RES was 100%, whereas for the detection of submucosal/mucosal layer involvement, the sensitivity was 89%, specificity was 26%, PPV was 55%, NPV was 71%, test accuracy was 58% and positive and negative LRs were 1.21 and 0.40, respectively. CONCLUSIONS RES is a valuable tool for detecting rectal endometriosis as endometriotic infiltration of the muscularis layer can be predicted accurately. However, RES is less accurate in detecting submucosal/mucosal layer involvement and cannot, therefore, be used to choose between bowel resection and a more conservative approach.
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Affiliation(s)
- L Rossi
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France
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Mangler M, Medrano N, Bartley J, Mechsner S, Speiser D, Schneider A, Köhler C. Value of diagnostic procedures in rectovaginal endometriosis. Aust N Z J Obstet Gynaecol 2013; 53:389-94. [DOI: 10.1111/ajo.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mandy Mangler
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Natalie Medrano
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Julia Bartley
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | - Sylvia Mechsner
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
| | | | - Achim Schneider
- Department of Gynecology; Charité Campus Mitte; Berlin; Germany
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11
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Gauche Cazalis C, Koskas M, Martin B, Palazzo L, Madelenat P, Yazbeck C. [Preoperative imaging of deeply infiltrating endometriosis in: Transvaginal sonography, rectal endoscopic sonography and magnetic resonance imaging]. ACTA ACUST UNITED AC 2012; 40:634-41. [PMID: 23123282 DOI: 10.1016/j.gyobfe.2012.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Compare the accuracy of transvaginal ultrasonography (TVUS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) before deeply infiltrating endometriosis surgery. PATIENTS AND METHODS A retrospective study with 25 deeply endometriosis patients underwent the three imaging examinations before surgery. Calculation of sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the different locations: ovaries, uterosacral ligaments and torus, rectovaginal septum, rectosigmoid junction, bladder. RESULTS Ovarian and deep pelvic endometriosis was found in surgery and confirmed by histology in all patients. Sensitivity and specificity are respectively: for ovaries: 88.2% and 71% of TVUS; 80% and 81.2% of RES; 87.5% and 71% of MRI. For uterosacral ligaments: 63% and 82,6% of TVUS; 37% and 100% of RES; 69% and 82.6% of MRI. For torus: 57.1% and 100% of TVUS; 76.2% and 100% of RES; 76.2% and 100% of MRI. For rectovaginal septum: 63.2% and 100% for TVUS; 89.5% and 66.7% of EER; 47.4% and 100% of MRI. For rectosigmoid junction: 73.7% and 66.7% of TVUS; 94.7% and 66.7% of RES; 89.5% and 50% of MRI. For bladder: 16.7% and 100% of TVUS; 16.7% and 100% of RES; 33.3% and 89.5% of MRI. DISCUSSION AND CONCLUSION We found that TVUS is the more performant for endometriomas, it is MRI for torus, uterosacral ligaments and little bladder lesions, RES for rectovaginal septum and rectosigmoid junction. So in the clinical practice, the three imaging examinations are complementary for the preoperative assessment of deeply endometriosis.
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Affiliation(s)
- C Gauche Cazalis
- Service de gynécologie obstétrique, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
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Rossini LG, Ribeiro PA, Rodrigues FC, Filippi SS, Zago RDR, Schneider NC, Okawa L, Klug WA. Transrectal ultrasound - Techniques and outcomes in the management of intestinal endometriosis. Endosc Ultrasound 2012; 1:23-35. [PMID: 24949332 PMCID: PMC4062201 DOI: 10.7178/eus.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 03/16/2012] [Accepted: 03/26/2012] [Indexed: 01/30/2023] Open
Abstract
The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration.
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Affiliation(s)
- Lucio G.B. Rossini
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP) / French-Brazilian Centre of Endoscopic Ultrasonography (CFBEUS), Brazil
| | | | | | - Sheila S. Filippi
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP) / French-Brazilian Centre of Endoscopic Ultrasonography (CFBEUS), Brazil
| | - Rodrigo de R. Zago
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP) / French-Brazilian Centre of Endoscopic Ultrasonography (CFBEUS), Brazil
| | - Nutianne C. Schneider
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP) / French-Brazilian Centre of Endoscopic Ultrasonography (CFBEUS), Brazil
| | - Luciano Okawa
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP) / French-Brazilian Centre of Endoscopic Ultrasonography (CFBEUS), Brazil
| | - Wilmar A. Klug
- Medical School of Science of Santa Casa de São Paulo (FCMSCSP), Brazil
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KRUSE CHRISTINA, SEYER-HANSEN MIKKEL, FORMAN AXEL. Diagnosis and treatment of rectovaginal endometriosis: an overview. Acta Obstet Gynecol Scand 2012; 91:648-57. [DOI: 10.1111/j.1600-0412.2012.01367.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Weigel MT, Krämer J, Schem C, Wenners A, Alkatout I, Jonat W, Maass N, Mundhenke C. Differential expression of MMP-2, MMP-9 and PCNA in endometriosis and endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2012; 160:74-8. [DOI: 10.1016/j.ejogrb.2011.09.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/12/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022]
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15
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Goncalves MODC, Podgaec S, Dias JA, Gonzalez M, Abrao MS. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod 2009; 25:665-71. [PMID: 20023291 DOI: 10.1093/humrep/dep433] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Successful surgical treatment of deep bowel endometriosis depends on obtaining detailed information about the lesions, prior to the procedure. The objective of this study was to determine the capability of transvaginal ultrasonography with bowel preparation (TVUS-BP) to predict the presence of one or more rectosigmoid nodules and the deepest bowel layer affected by the disease. METHODS A prospective study of 194 patients with clinical and TVUS-BP suspected deep endometriosis submitted to videolaparoscopy. Image data were compared with surgical and histological results. RESULTS With respect to bowel nodule detection and presence of at least two rectosigmoid lesions, TVUS-BP had a sensitivity of 97 and 81%, specificity 100 and 99%, positive predictive value (PPV) 100 and 93% and negative predictive value (NPV) 98 and 96%, respectively. Regarding diagnosis of infiltration of the submucosal/mucosal layer, TVUS-BP had a sensitivity of 83%, specificity 94%, PPV 77%, NPV 96%. CONCLUSIONS These findings show that TVUS-BP is an adequate exam for evaluating the presence of one or more rectosigmoid nodules and the deepest layer affected in deep infiltrating bowel endometriosis, confirming the importance of this technique for defining the most appropriate surgical strategy to be implemented.
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Benbara A, Fortin A, Martin B, Palazzo L, Le Tohic A, Madelenat P, Yazbeck C. [Surgical and functional results of rectosigmoidal resection for severe endometriosis]. ACTA ACUST UNITED AC 2008; 36:1191-201. [PMID: 19019719 DOI: 10.1016/j.gyobfe.2008.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 09/24/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Indications of colorectal resection for endometriosis are controversial because of the risk of major complications. This study aims to evaluate the value of different diagnostic tests in decision-making, and to evaluate the surgical results and complications, as well as long-term functional results after surgery. PATIENTS AND METHODS In the set of a retrospective case series, 50 patients who have been admitted for a colorectal resection because of deep endometriosis were included. Most of them have had an MRI and an endorectal ultrasonography. Specific questionnaires have been proposed in order to evaluate symptoms, sexuality (BISF-W) and quality of life (EHP-30). RESULTS For the diagnosis of rectal involvement, the sensitivity of MRI and endorectal ultrasonography were 55 and 100%, respectively. Forty-one colorectal amputations and nine partial colorectal resections have been done by 24 laparotomies, two laparoscopies and 24 laparoconversions. Major complications included six (12.5%) digestive fistulas, three (6%) anastomotic strictures, one ureterovaginal fistula and one ureteral stricture. Risk factors associated with digestive fistulas were the association of a vaginal opening (p=0.002) and an additional ileocaecal resection (p=0.007). The mean follow-up period was of 42 months. A significant improvement of dysmenorrhea (p<10(-4)), dyschesia (p<10(-4)), chronic pelvic pain (p<10(-4)), and of some digestive symptoms such as catamenial epreintes (p=0.002) and catamenial diarrheas (p=0.006), was noted. We noted postoperative 14 dysurias, six constipations and 12 rectal polykynesias. Four patients have had deep recurrent lesions. Twenty patients had a desire of pregnancy after the operation, 17 pregnancies were obtained (eight spontaneous and nine by ART) giving birth to 14 living children. Sexuality evaluation was below normal range. The quality of life was improved for most of the items. The global satisfaction was good (91%). DISCUSSION AND CONCLUSION Colorectal resection for deep endometriosis improve significantly most of the pain symptoms, but the women should have detailed counselling about the risks of major complications and recurrence.
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Affiliation(s)
- A Benbara
- Service de gynécologie-obstétrique, hôpital Bichat Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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Roman H, Kouteich K, Gromez A, Hochain P, Resch B, Marpeau L. Endorectal ultrasound accuracy in the diagnosis of rectal endometriosis infiltration depth. Fertil Steril 2008; 90:1008-13. [DOI: 10.1016/j.fertnstert.2007.07.1361] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 07/23/2007] [Accepted: 07/23/2007] [Indexed: 12/18/2022]
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Popoutchi P, dos Reis Lemos CR, Silva JCRE, Nogueira AA, Feres O, Ribeiro da Rocha JJ. Postmenopausal intestinal obstructive endometriosis: case report and review of the literature. SAO PAULO MED J 2008; 126:190-3. [PMID: 18711660 DOI: 10.1590/s1516-31802008000300010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 05/05/2008] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.
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Affiliation(s)
- Pedro Popoutchi
- Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto,São Paulo, Brazil
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Yoshida M, Watanabe Y, Horiuchi A, Yamamoto Y, Sugishita H, Kawachi K. Sigmoid colon endometriosis treated with laparoscopy-assisted sigmoidectomy: Significance of preoperative diagnosis. World J Gastroenterol 2007; 13:5400-2. [PMID: 17879416 PMCID: PMC4171336 DOI: 10.3748/wjg.v13.i40.5400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a female patient with sigmoid colon endome-triosis who was diagnosed correctly preoperatively and underwent minimally invasive surgery. She was admitted to our hospital with rectal bleeding and constipation. We performed several workups. Colonoscopy and endoscopic ultrasonography showed sigmoid colon stenosis caused by submucosal tumor, and magnetic resonance imaging revealed a sigmoid colon tumor displaying signal hy-pointensity on both T1- and T2-weighted imaging. However, colonoscopic ultrasonography-assisted needle aspiration biopsy could not specify tumor characteristics. From these examinations, the lesion was diagnosed as sigmoid colon endometriosis and laparoscopy-assisted sigmoidectomy was performed. Pathological diagnosis from the resected specimen was identical to preoperative diagnosis, i.e., colonic endometriosis. Since differential diagnosis of intestinal endometriosis seems difficult, a cautious preoperative diagnosis is required to select treatments including minimally invasive surgery.
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Affiliation(s)
- Motohira Yoshida
- Department of Organ Regenerative Surgery, Ehime University, Shitsukawa, Toon, Ehime 791-0295, Japan.
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Abstract
BACKGROUND The aim of this paper is to review the results of surgical excision of rectal endometriosis and review the published work on this challenging condition. METHODS All cases of endometriosis involving the rectum treated by a single colorectal surgeon were identified from a prospective database and the results reviewed. RESULTS Between 1995 and 2005, 213 rectal procedures were carried out on 203 patients together with an endogynaecologist. Eighteen cases involved dissection of endometriosis off the rectal wall, 58 involved full-thickness excision of the anterior rectal wall and 137 segmental excisions of the rectum were carried out. A loop ileostomy was required in 7 (5%) of the segmental resections. Seventy-five per cent of the cases were either laparoscopic or laparoscopically assisted. Infertility was significantly more common in the group requiring a segmental resection (P=0.026) and a history of rectal pain during defecation more common in patients having dissection of endometriosis off the rectal wall (P=0.031). There were no other significant differences between the different types of rectal surgery. The morbidity for all rectal procedures was 7% and there was one anastomotic leak in the segmental resection group. The actuarial rectal recurrence rate of endometriosis was 22.2% 95% confidence interval (CI) (2.5, 42.0) for dissection off the rectal wall and this was significantly different from the recurrence of 5.17% 95%CI (0.0, 10.9) for anterior rectal wall excision and 2.19% 95%CI (0.0, 4.6) for segmental rectal resection (P=0.007). The overall rectal recurrence for all cases was 4.69% 95%CI (1.8, 7.5). CONCLUSION Endometriosis of the rectum can be successfully treated with low morbidity and low recurrence rates by excising the disease as completely as possible using full-thickness excision of the anterior rectal wall or segmental resection of the rectum.
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Affiliation(s)
- Richard Brouwer
- Department of Colorectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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Kanthimathinathan V, Elakkary E, Bleibel W, Kuwajerwala N, Conjeevaram S, Tootla F. Endometrioma of the large bowel. Dig Dis Sci 2007; 52:767-9. [PMID: 17268828 DOI: 10.1007/s10620-006-9623-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 09/24/2006] [Indexed: 12/09/2022]
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L’écho-endoscopie dans le diagnostic del’endométriose digestive. IMAGERIE DE LA FEMME 2006. [DOI: 10.1016/s1776-9817(06)73050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Biscaldi E, Ferrero S, Fulcheri E, Ragni N, Remorgida V, Rollandi GA. Multislice CT enteroclysis in the diagnosis of bowel endometriosis. Eur Radiol 2006; 17:211-9. [PMID: 16937103 DOI: 10.1007/s00330-006-0364-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 04/30/2006] [Accepted: 06/13/2006] [Indexed: 12/19/2022]
Abstract
This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions.
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Affiliation(s)
- Ennio Biscaldi
- Department of Radiology, Duchesse of Galliera-Hospital, Via Mura delle Cappuccine 14, 16128 Genoa, Italy.
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Jarmin R, Idris MA, Shaharuddin S, Nadeson S, Rashid LM, Mustaffa WMW. Intestinal Obstruction Due to Rectal Endometriosis: A Surgical Enigma. Asian J Surg 2006; 29:149-52. [PMID: 16877213 DOI: 10.1016/s1015-9584(09)60075-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Obstructed rectal endometriosis is an uncommon presentation. The clinical and intraoperative presentation may present as malignant obstruction. The difficulty in making the diagnosis may delay the definitive management of the patient. We report a unique case of rectal endometriosis mimicking malignant rectal mass causing intestinal obstruction and discuss the management of the case.
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Affiliation(s)
- Razman Jarmin
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Bahr A, de Parades V, Gadonneix P, Etienney I, Salet-Lizée D, Villet R, Atienza P. Endorectal ultrasonography in predicting rectal wall infiltration in patients with deep pelvic endometriosis: a modern tool for an ancient disease. Dis Colon Rectum 2006; 49:869-75. [PMID: 16583293 DOI: 10.1007/s10350-006-0501-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This study evaluated the validity of endorectal ultrasonography in predicting rectal infiltration in patients with deep pelvic endometriosis. METHODS Patients were recruited consecutively in the Department of Surgical Gynecology of Diaconesses Hospital from April 1996 to July 2003. Inclusion criteria were the suspicion of deep pelvic endometriosis on the basis of outpatient history and/or clinical symptoms with a mass palpable on bimanual examination that might infiltrate the rectal wall. There were no exclusion criteria. Endorectal ultrasonography was performed by the same investigator with a 7.5-MHz to 10-MHz rigid probe, producing a 360 degrees view of the rectal wall and adjacent areas. We used surgical and histopathologic findings as the "gold standard" to evaluate the validity of endorectal ultrasonography. RESULTS This study was based on 37 patients (mean age, 35.8 (range, 26-46) years) who underwent surgery. The time between endorectal ultrasonography and surgery ranged from 4 to 529 (mean, 88.7) days. Eight patients had endometriosis nodules penetrating the rectal wall. Endorectal ultrasonography showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 87.5, 97, 87.5, and 97 percent, respectively, in the diagnosis of infiltration of the rectal wall by endometriosis. CONCLUSIONS Endorectal ultrasonography is a reliable technique for visualizing rectal infiltration in patients with deep pelvic endometriosis. It should be more widely used by gynecologists because knowing about rectal infiltration before surgery is fundamental to defining the best possible surgical approach.
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Affiliation(s)
- Abbas Bahr
- Proctologie Médico-Interventionnelle, Groupe Hospitalier Diaconesses--Croix Saint Simon, Paris, France
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Pishvaian AC, Ahlawat SK, Garvin D, Haddad NG. Role of EUS and EUS-guided FNA in the diagnosis of symptomatic rectosigmoid endometriosis. Gastrointest Endosc 2006; 63:331-5. [PMID: 16427951 DOI: 10.1016/j.gie.2005.06.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Accepted: 06/09/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rectosigmoid endometriosis is an underrecognized cause of GI symptoms in women. Pelvic magnetic resonance imaging and CT have a low sensitivity in making this diagnosis. The role of EUS and EUS-guided FNA (EUS-FNA) in the diagnosis of rectosigmoid endometriosis in symptomatic patients is not well studied. METHODS A review of medical records identified 5 women who were diagnosed with rectosigmoid endometriosis by EUS and EUS-FNA over a period of 1 year. OBSERVATIONS Five women with nonspecific GI complaints underwent EUS examination of a rectosigmoid subepithelial mass found on colonoscopy. EUS revealed a hypoechoic lesion infiltrating the muscularis propria and the serosa of the rectal wall, and extending outside the rectal wall, findings consistent with rectosigmoid endometriosis. This diagnosis was confirmed by EUS-FNA, surgical exploration, and/or the patient's clinical course. CONCLUSIONS EUS and EUS-FNA are noninvasive, sensitive techniques for the diagnosis of rectosigmoid endometriosis in symptomatic patients.
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Affiliation(s)
- Aline Charabaty Pishvaian
- Division of Gastroenterology and Department of Pathology, Georgetown University Hospital, Washington DC, USA
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Amso NN, Griffiths A. The role and applications of ultrasound in ambulatory gynaecology. Best Pract Res Clin Obstet Gynaecol 2005; 19:693-711. [PMID: 16257581 DOI: 10.1016/j.bpobgyn.2005.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ultrasound has changed gynaecological practice and continues to do so. One of the earliest applications of abdominal scanning in gynaecology was for monitoring follicular development during fertility treatment with clomiphene citrate or gonadotrophins in the 1960s and 1970s. Subsequently, it was natural that with the introduction of in vitro fertilization, abdominal and transvaginal ultrasound played a key role in the development of oocyte retrieval techniques. These were truly the first interventional ultrasound-guided ambulatory procedures in gynaecology. In this chapter, the reader will be introduced to the roles that the various ultrasound modalities play in our current daily practice, and how they have changed the management of numerous gynaecological conditions in both diagnostic and therapeutic contexts. We will also outline the recent developments and the 'hot' research topics in this field.
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Affiliation(s)
- Nazar N Amso
- Department of Obstetrics & Gynaecology, Wales College of Medicine, Cardiff University, University Hospital of Wales, Heath Park, UK.
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Lamvu G, Tu F, As-Sanie S, Zolnoun D, Steege JF. The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain. Obstet Gynecol Clin North Am 2004; 31:619-30, x. [PMID: 15450323 DOI: 10.1016/j.ogc.2004.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Laparoscopy is a useful tool for the diagnosis and treatment of conditions associated with chronic pelvic pain. In the evaluation of chronic pelvic pain, laparoscopic techniques vary from conservative procedures, such as pain mapping, excision, and nerve ablation, to more extensive procedures like oophorectomy and hysterectomy. Although useful for diagnosis, laparoscopy continues to have a controversial role in the treatment of chronic pelvic pain.
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Affiliation(s)
- Georgine Lamvu
- Division of Advanced Laparoscopy and Gynecologic, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, 27599-7508, USA.
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