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Barium Enema Evaluation of Colonic Involvement in Endometriosis

Niccolò Faccioli1, Riccardo Manfredi1, Paride Mainardi2, Emiliano Dalla Chiara2, Elide Spoto2, Luca Minelli3 and Roberto Pozzi Mucelli1

1 Department of Radiology, University of Verona, Policlinico G. B. Rossi, Piazzale Scuro 10, 37134 Verona, Italy.
2 Department of Radiology, Sacro Cuore Hospital, Negrar, Verona, Italy.
3 Department of Gynecology, Sacro Cuore Hospital, Negrar, Verona, Italy.


Figure 1
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  		Fig. 1A —34-year-old woman with suspected intestinal implants of endometriosis. Lateral (A) and oblique (B) spot images show three endometriotic lesions exhibiting extrinsic mass effect with crenulation of contour and spiculation that are direct signs of infiltration of bowel wall (arrows). Small polypoid lesion (arrowhead) is benign tubular adenoma confirmed at surgery.

 

Figure 2
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  		Fig. 1B —34-year-old woman with suspected intestinal implants of endometriosis. Lateral (A) and oblique (B) spot images show three endometriotic lesions exhibiting extrinsic mass effect with crenulation of contour and spiculation that are direct signs of infiltration of bowel wall (arrows). Small polypoid lesion (arrowhead) is benign tubular adenoma confirmed at surgery.

 

Figure 3
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  		Fig. 2 —28-year-old woman with suspected intestinal implants of endometriosis and finding of rectal localization of intestinal endometriosis. Double-contrast barium enema image shows extrinsic mass effect and spiculation (arrow) of rectal wall that appears infiltrated. Surgical and histologic findings confirmed intestinal implants of endometriosis.

 

Figure 4
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  		Fig. 3 —23-year-old woman with suspected intestinal implants of endometriosis. Double-contrast barium enema examination showed pathologic pelvic process involving bowel serosa at rectosigmoid junction. Finding of extrinsic mass effect and spiculation (arrows) owing to poor wall distention after air insufflation suggested endometriotic wall infiltration. Histologic examination of these alterations showed adnexal inflammation originating from ovary.

 

Figure 5
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  		Fig. 4A —31-year-old woman with suspected intestinal implants of endometriosis and finding of cecal localization of intestinal endometriosis. Double-contrast barium enema image of cecum shows endometriotic localization as endoluminal filling defect (arrow) due to wide extrinsic mass effect confirmed at surgery.

 

Figure 6
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  		Fig. 4B —31-year-old woman with suspected intestinal implants of endometriosis and finding of cecal localization of intestinal endometriosis. Photograph of surgical specimen shows endometrial glands and stroma infiltrating fibromuscular tissue, smooth-muscle proliferation, and fibrous reaction, resulting in thickening of wall with endometriosis. Multiple cysts (arrow) are present in perivisceral fat tissue. Mucosal sparing is typical of this disease.

 

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