HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hensen, J.-H. J. Articles by Puylaert, J. B. C. M. Search for Related Content PubMed PubMed Citation Articles by Hensen, J.-H. J. Articles by Puylaert, J. B. C. M. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound

¹ Department of Radiology, Maasstad Hospital, Olympiaweg 350, PO Box 9119, Rotterdam, Zuid Holland NL-3075 EA, The Netherlands.
² Department of Radiology, MCH Westeinde Hospital, The Hague, The Netherlands.

OBJECTIVE. The purpose of our study was to evaluate the clinical findings and transvaginal ultrasound features of posterior cul-de-sac endometriosis.

MATERIALS AND METHODS. A retrospective search of cases over a 13-year period was performed and yielded 25 patients with posterior cul-de-sac endometriosis. The diagnosis of posterior cul-de-sac endometriosis was confirmed by histology (n = 13), conventional barium enema (n = 13), colonoscopy (n = 8), CT (n = 8), MRI (n = 17), diagnostic laparoscopy (n = 14), and laparotomy (n = 13). All patients underwent transvaginal and abdominal ultrasound including power Doppler examination. Two radiologists working in consensus analyzed the clinical data and reviewed the imaging studies.

RESULTS. All 25 patients presented with lower abdominal pain that was cyclic in six patients. Eleven patients were unintended childless. Rectal discomfort was mentioned by 17 patients, two of whom also reported rectal blood loss. At physical examination, eight patients had a palpable mass in the posterior cul-de-sac. Transvaginal ultrasound detected one or more hypoechoic masses in the posterior cul-de-sac in all 25 patients. All masses were solid, noncompressible, and localized on the serosal surface of the rectosigmoid with sparing of mucosa and submucosa. The lesions had a rounded or ovoid shape and a mean sagittal diameter of 37 mm with vascularity. The masses had a spiculated or tethering contour in 19 patients. Abdominal ultrasound detected thick-walled adnexal cysts in 11 patients, hydronephrosis in eight, and involvement of the ileocecal region in five.

CONCLUSION. Patients with endometriosis of the posterior cul-de-sac frequently present with atypical noncyclic symptoms. The transvaginal ultrasound features characteristic of posterior cul-de-sac endometriosis are a solid, often spiculated, noncompressible mass near the posterior cul-de-sac that is localized at the serosal surface of the rectosigmoid, spares the mucosa and submucosa, and is vascular.

Keywords: endometriosis • posterior cul-de-sac • rectovaginal septum • transvaginal ultrasound • women's imaging

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?