Deep infltrating endometriosis.

Abstract

Endometriosis is a common and often debilitating gynaecologica disorder that afects 5-10% of women. The prevalence is even higher among women with symptoms of endometriosis. Approximately 80% of women sufering from endometriosis have superfcial lesions while 20% have deep infltrating endometriosis (DIE). Laparoscopy is the gold standard for diagnosing endometriosis as it allows diagnosis of all forms of endometriosis and often immediate remova of superfcial endometriosis. The removal of deep infltrating endometriosis is signifcantly 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 10 years, it has been well established in the literature that transvaginal ultrasound allows preoperative diagnosis of deep infltrating 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. This presentation gives an overview of what the referring clinician can expect with regard to the preoperative transvaginal ultrasound diagnosis of pouch of Douglas obliteration and deep infltrating endometriosis involving the bowel, the bladder, the vagina and the uterosacral ligaments.