Adenomyosis and Endometriomas & Assessing the Rectosigmoid Colon

Abstract

Endometriosis is a common and often debilitating gynaecological disorder that affects 5-10% of women. The prevalence is even higher among women with symptoms of endometriosis. Approximately 80% of women suffering from endometriosis have superficial lesions while 20% have deep infiltrating endometriosis. Laparoscopy has always been considered the gold standard for diagnosing endometriosis as it allows diagnosis of both forms of endometriosis and often immediate removal of superficial endometriosis. The removal of deep infiltrating endometriosis is however significantly more complex, particularly when pouch of Douglas obliteration, bowel nodules or bladder nodules are present. Unless it was diagnosed preoperatively, the removal can usually not be completed because a multidisciplinary approach is often required with the involvement of a urologist or a colorectal surgeon. Over the last 15 years it has been well established in the literature that transvaginal ultrasound allows preoperative diagnosis of deep infiltrating endometriosis. The preoperative diagnosis of DIE with transvaginal ultrasound facilitates a more patient-centred approach to endometriosis management because an accurate preoperative documentation of the location and extent of the disease allows for referral to an endometriosis expert and/or bowel surgeon, better preoperative planning, less repetitive surgery, and better outcomes for women. The presentation on ‘Endometriomas and Adenomyosis’ will highlight the importance of these findings as red flags for the presence of deep endometriosis but also touch on how these conditions change over time with pregnancy and menopause. The presentation on ‘Assessing the rectosigmoid colon’ gives an overview on how to systematically assess the rectosigmoid for the presence of deep endometriosis nodules, and when this assessment must be included in the assessment of the pelvis.