Ultrasound evaluation of pouch of Douglas obliteration and rectal deep endometriosis in women who have had previous combined colorectal and gynaecological laparoscopic surgery for rectal endometriosis: A pilot study.
colectomy
endometriosis
multidisciplinary research
rectouterine pouch
ultrasonography
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
05
05
2019
accepted:
01
12
2019
pubmed:
11
1
2020
medline:
1
12
2020
entrez:
11
1
2020
Statut:
ppublish
Résumé
Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
Sections du résumé
BACKGROUND
Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated.
AIM
To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE.
MATERIALS AND METHODS
An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done.
RESULTS
Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology.
CONCLUSION
Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
258-263Informations de copyright
© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Giudice LC. Endometriosis. N Engl J Med 2010; 362: 2389-2398.
Hadfield R, Mardon H, Barlow D et al. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 1996; 11: 878-880.
Leonardi M, Condous G. How to perform an ultrasound to diagnose endometriosis. Australas J Ultrasound Med 2018; 21: 61-69.
Nisenblat V, Bossuyt PMM, Farquhar C et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2: CD009591.
Guerriero S, Condous G, van den Bosch T et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol 2016; 48: 318-332.
Reid S, Lu C, Casikar I et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol 2013; 41: 685-691.
Hudelist G, Fritzer N, Staettner S et al. Uterine sliding sign: A simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol 2013; 41: 692-695.
Wolthuis AM, Meuleman C, Tomassetti C et al. Bowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 2014; 20: 15616-15623.
Nezhat C, Li A, Falik R et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol 2018; 218: 549-562.
Dubernard G, Piketty M, Rouzier R et al. Quality of life after laparoscopic colorectal resection for endometriosis. Hum Reprod 2006; 21: 1243-1247.
Riiskjaer M, Forman A, Kesmodel US et al. Pelvic pain and quality of life before and after laparoscopic bowel resection for rectosigmoid endometriosis. Dis Colon Rectum 2018; 61: 221-229.
The STROBE. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349.
European federation of societies for ultrasound in medicine and biology. Minimum training recommendations for the practice of medical ultrasound. Appendix 3. Gynaecological ultrasound. Ultraschall der Medizin. 2006; 27: 79-105.
Cheong Y, Tay P, Luk F et al. Laparoscopic surgery for endometriosis: How often do we need to re-operate? J Obstet Gynaecol (Lahore) 2008; 28: 82-85.
Aredo J, Heyrana K, Karp B et al. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Semin Reprod Med 2017; 35: 088-097.
Leyland N, Casper R, Laberge P et al. Endometriosis: diagnosis and management. J Obstet Gynaecol Canada 2010; 32: S1-S28.
Ambrosetti P, Robert J, Mathey P et al. Left-sided colon and colorectal anastomoses: doppler ultrasound as an aid to assess bowel vascularization - A prospective evaluation of 200 consecutive elective cases. Int J Colorectal Dis 1994; 9: 211-214.
Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril 2017; 108: 931-942.
Guo S-W. Recurrence of endometriosis and its control. Hum Reprod Update 2009; 15: 441-461.