VAGINAL ENDOSONOGRAPHY TO DIAGNOSE ENTEROCOELE

Radiological diagnosis of enterocoele is possible using evacuation pro ctography, but the standard technique must be modified to reveal the s mall bowel. Since prolapsed bowel is interposed between the vagina and rectum, diagnosis may be possible using vaginal endosonography. We de scribe a simple ultrasound technique to diagnose enterocoele, which ha s been validated by comparison with proctography. 17 women were examin ed with vaginal endosonography, and a diagnosis of enterocoele made if bowel was visualized in the rectovaginal space when bearing down. The findings were compared with subsequent proctography. In eight cases ( 47%) bowel prolapsed into the rectogenital space during straining, obs curing the rectum, while this did not occur in the remaining nine subj ects (53%). Proctography confirmed an enterocoele in six of the eight cases in whom it had been diagnosed on endosonography, and confirmed t he absence of enterocoele in all of the nine cases negative on endoson ography. These values gave vaginal endosonography a sensitivity of 100 % and specificity of 82%, with a positive predictive value of 75%, and negative predictive value of 100% for a prevalence of abnormality of 0.35. Vaginal endosonography is a quick, easy and convenient alternati ve to evacuation proctography for the radiological diagnosis of entero coele.