Sonographic Assessment of Pelvic Endometriosis

Abstract

Introduction Endometriosis is a common gynaecological problem, affecting approximately 5 per cent of women [1]. The diagnosis can take many years [2] and the condition can cause debilitating pain and infertility. The disease can be found in many sites throughout the pelvis, in particular the ovaries, pelvic peritoneum, pouch of Douglas (POD), rectum, rectosigmoid, rectovaginal septum (RVS), uterosacral ligaments (USLs), vagina and urinary bladder. Mapping of deeply infiltrating disease is essential to enable the correct counselling regarding treatment modalities (medical or surgical) and risks of surgery, triaging to the correct surgical centre, informing the surgeon in order to correctly plan surgery and enabling other specialities, such as colorectal or urology support, to be organized in advance. Magnetic resonance imaging (MRI) has been used as the main pre-operative imaging modality, but with the correct training and experience transvaginal ultrasound can perform the same role [3]. Vaginal digital examination has been shown to be inferior diagnostically to transvaginal scanning (TVS) [4]. Before undertaking any ultrasound examination it is vital to first assess and clearly document the symptoms that have led to the examination. The history should include general gynaecological history and features specific to endometriosis, including: parity; menstrual period; previous surgery including laparoscopic or open; family history of endometriosis; previous non-surgical treatment for endometriosis (type, duration, effect); subfertility including duration; treatment for infertility and outcome of fertility treatment; pain (dysmenorrhoea, dyspareunia, dysuria, dyschezia, non-cyclic pelvic pain). The onset and duration of symptoms should be noted and the intensity of the pain symptoms should be objectively assessed using a 1–10 visual analogue score. Cyclic haematochezia and/or haematuria associated with menstruation are of particular significance.