Ultrasound Diagnosis of Bowel Endometriosis

Abstract

Background: Bowel endometriosis is one of the more severe manifestations of deep endometriosis; it may causepain and intestinal symptoms. The noninvasive diagnosis of bowel endometriosis is of crucial importance in planning the management of patients affected by this condition. Objectives: This review aims to describe how transvaginal ultrasonography (TVS) is performed in patients with suspi cion of rectosigmoid endometriosis, the diagnostic perfor mance, and the strengths and limitations of this technique. Methods: To identify relevant literature, a literature search was performed across the PubMed and Google Scholar databases up to July 2024. Outcome: Numerous meta analyses have demonstrated that TVS has high diagnostic accuracy in diagnosing rectosigmoid endometriosis. Rec tosigmoid nodules can present with different morphological characteristics, but they are typically described as irregular, hypoechoic nodules located in the anterior wall of the rectosigmoid colon. The presence of "softmarkers,"such asa negative sliding sign and kissing ovaries, can further rein force the diagnosis of this condition. Posterolateral para metrial involvement often coexists with large rectal nodules. Introducing water contrast into the rectosigmoid does not improve the performanceof TVSindiagnosing rectosigmoid endometriosis. Conclusions and Outlook: TVS should be the f irst-line investigation in women suspected of having rec tosigmoid endometriosis. The widespread use of TVS for the diagnosis of intestinal endometriosis can reduce diagnostic delays and facilitate the treatment of patients affected by this condition.