TRANSRECTAL ULTRASONOGRAPHY IN THE ASSESSMENT OF RECTOVAGINAL ENDOMETRIOSIS

Objective: To evaluate the validity of transrectal ultrasonography in the assessment of rectovaginal endometriosis. Methods: We compared the findings of transrectal ultrasonographic examination performed before surgery with the operative and pathologic findings in 140 women who u nderwent laparoscopy or laparotomy for suspected endometriosis. The ul trasonographer was asked to investigate whether any deep endometriotic lesions were present in the rectovaginal septum and to define the lat eral extension on the basis of involvement of the uterosacral ligament s. Ln addition, infiltration of the rectal and vaginal walls was evalu ated. Results: Thirty-four women had endometriosis infiltrating the re ctovaginal septum confirmed by combined operative and pathologic findi ngs. Ultrasonography showed a sensitivity and specificity of 97% and 9 6%, respectively, in the diagnosis of the presence of rectovaginal end ometriosis. The sonographer identified infiltration of the rectal and vaginal walls correctly in all cases in whom it was present, but also reported rectal infiltration in three cases not confirmed by the surge on and pathologist. The sensitivity and specificity in the diagnosis o f uterosacral Ligament infiltration were 80% and 97%, respectively. Co nclusion: If our preliminary results are confirmed by a larger series, transrectal ultrasonography will be considered a valid diagnostic too l in the evaluation at: rectovaginal endometriosis. (C) 1998 by The Am erican College of Obstetricians and Gynecologists.