Gynaecological examination coupled with transvaginal ultrasound in the diagnosis of rectosigmoid endometriosis

Aims: An accurate preoperative diagnosis of deep infiltrating endometriosis of recto-sigma is essential for an adequate counselling and surgical therapy.

Objective: To assess the value of gynaecological examination and transvaginal ultrasound in the diagnosis of rectosigmoid endometriosis.

Patients: 674 patients operated for clinical symptoms and/or signs of endometriosis between May 2005 and December 2006at the county hospital of Villach (Austria).

Methods: Prospectively, the preoperative gynaecological examination and transvaginal ultrasound findings were assessed and compared to the surgical/pathological findings of the same patients (gold standard).

Results: 97 patients undergone segmental intestinal resection. All resulted affected by at least one deep infiltrating nodule of the recto-sigma and, among them, 40 by 2 or more, 5 by 3 or more and 2 by 4 distinct nodules. The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and phi correlation coefficient in the diagnosis of at least one nodule were respectively 86%, 99%, 94%, 98%, 0.88 and 97%, 99%, 92%, 99% 0.94 for the gynaecological examination and transvaginal ultrasound. No second nodules were preoperatively palpable and the above-mentioned parameters in the diagnosis of two or more nodules by US were 22%, 99%, 69%, 95% and 0.37 respectively.

Conclusion: Gynaecological examination coupled with transvaginal ultrasound is a very reliable approach in the preoperative assessment of rectosigmoid endometriosis.