Rectal endometriosis imaging: A case based pictorial essay

Abstract

Endometriosis is a common chronic gynecological disorder presenting with cyclical pain and infertility in premenopausal females. In some patient's endometrial lesions can be advanced and infiltrate deep into the peritoneum (deep infiltrating endometriosis (DIE)) and pelvic organs, and cases can be challenging for management. Posterior compartment endometriosis, in particular involvement of the recto-sigmoid can be challenging for surgeons, and presurgical detection and proper characterization of involvement on imaging is prudent. Ultrasound and MR are the main modalities to evaluate pelvic endometriosis. Imaging evaluation requires identifying the number, location, and size of the lesions, as well as the degree of depth and circumferential involvement of the rectum. To better explain imaging evaluation and characterization of rectal endometriosis, in this paper we have elaborated pictorial review of 14 surgically proven rectal endometriosis cases. We have also mentioned about the rectal endometriosis reporting guidelines set by Society of Abdominal Radiology (SAR). To our knowledge presently there are no dedicated pictorial reviews specific to rectal endometriosis encompassing both US, MR and SAR guidelines in the English literature.