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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.

Manoel Orlando da C. Goncalves1,2, Sergio Podgaec3,4, Joao Antonio Dias Jr.3,4, Midgley Gonzalez3, and Mauricio S. Abrao3,4,5

1Digimagem, 04534-010 Sa˜o Paulo, Brazil 2RDO Diagno´ sticos Me´dicos, 01430-000 Sa˜o Paulo, Brazil 3Department of Obstetrics and
Gynecology, University of Sa˜o Paulo Medical School, 05405-000, Sa˜o Paulo, Brazil 4Sirio Libanes Hospital, 01308-050 Sa˜o Paulo, Brazil
5Correspondence address. Rua Sao Sebastiao 550, 04708-001 Sao Paulo, SP, Brazil. Tel: þ55-11-5180-3344; Fax: þ55-11-5182-2671,
E-mail: msabrao@mac.com

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.
Key words: endometriosis / bowel / ultrasonography / laparoscopy / diagnosis

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