Computed tomography colonoscopy

Abstract

The aim of this chapter is to introduce the role of computed tomography colonoscopy (CTC) for the diagnosis of bowel endometriosis. CTC provides accurate information on the characteristic of endometriotic intestinal nodule and precisely assess the distance between its localization and the anal verge. A further relevant advantage of this radiologic exam is that it provides an overview of the whole colon and, in particular, of the intestinal nodules which are located above the sigmoid colon. Considering that in 39% of cases bowel lesions are multifocal, a complete assessment of the colon is essential to detect all endometriotic lesions before surgery; in fact, multiple endometriotic nodules on the digestive tract may require multiple segmental bowel resections or disc excisions. CTC is a quick outpatient exam with high spatial resolution, and it allows scanning the abdomen within seconds; moreover, it is safe and minimally painful for the patients, not requiring analgesia or sedation. Colonic distension with CO2 and combination of prone and supine positions provide better estimation of digestive tract narrowness than that of any other imaging techniques. However, CTC should not be considered as an alternative to TVS or MRI, because these imaging techniques provide a better assessment of deep pelvic endometriosis, ovarian endometriomas, and uterine adenomyosis.