Ultrasound evaluation of deep infiltrating endometriosis
A.D. Stănescu, R.M. Sima, D.O. Bălălău, A. Talpalaru, L. Pleș
Rezumat: Introduction. Endometriosis with different stages of severity
affects approximately 5% of women. It can involve
the ovaries, the pelvic peritoneum, the pouch of Douglas (POD),
the rectum, the rectosigmoid junction, the rectovaginal
septum (RVS), the uterosacral ligaments (USL), the vagina
and the bladder. The ultrasound evaluation is the firsthand
method to detect ovarian endometriosis, but recently it
has proven its value in the diagnosis of deep infiltrating
endometriosis (DIE). Materials and method. We have
evaluated the medical database and international guides
regarding ultrasound examination of DIE. Results. Recent
data prove that the purpose of ultrasound examination of
a woman suspected of endometriosis is to explain the main
symptoms, to identify the lesions and to evaluate the grade
of severity before choosing the appropiate conservatory or
surgical means of therapy. Using transvaginal ultrasound
as the first means of diagnosis, the examiner must first
evaluate the uterus and adnexa. Ovarian endometriomas
are frequently associated with other endometriosis-specific
lesions such as adhesions and DIE. The second step is to look
for “soft markers” and to test the mobility of the ovaries.
The presence of these signs increases the chance that
DIE and adhesions are to be found. By applying pressure
between the uterus and ovaries, one can test whether the
ovaries are fixed to the uterosacral ligaments, medially
or laterally to adjacent structures. The third step is the
evaluation of the pouch of Douglass using the sliding
sign. The fourth and final step is to search for DIE nodules
in the anterior and posterior compartments of the pelvis.
Conclusions. Transvaginal ultrasound is the firsthand method of evaluating patients with ovarian endometriosis and DIE. The prediction of severe forms of DIE, as well as the obliteration of the pouch of Douglas are essential in planning a multidisciplinary surgical approach. Cuvinte cheie: ultrasound, endometriosis, recto-vaginal
septum, pelvic pain, Douglas.