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Review
. 2012 Apr;1(1):23-35.
doi: 10.7178/eus.01.005.

Transrectal ultrasound - Techniques and outcomes in the management of intestinal endometriosis

Lucio G B Rossini  1 , Paulo A A G Ribeiro  2 , Francisco C M Rodrigues  2 , Sheila S Filippi  1 , Rodrigo de R Zago  1 , Nutianne C Schneider  1 , Luciano Okawa  1 , Wilmar A Klug  2
Affiliations
Review

Transrectal ultrasound - Techniques and outcomes in the management of intestinal endometriosis

Lucio G B Rossini et al. Endosc Ultrasound. 2012 Apr.

Abstract

The widespread use of endoscopic ultrasound has facilitated the evaluation of subepithelial and surrounding lesions of the gastrointestinal tract. Deep pelvic endometriosis, with or without infiltration of the intestinal wall, is a frequent disease that can be observed in women in their fertile age. Patients of this disease may present nonspecific signs and symptoms or be completely asymptomatic. Laparoscopic surgical resection of endometriotic lesions is the treatment of choice in symptomatic patients. An accurate preoperative evaluation is indispensable for therapeutic decisions mainly in the suspicion of intestinal wall and/or urinary tract infiltration, and also in cases where we need to establish histological diagnosis or to rule out malignant disease. Diagnostic tools, including transrectal ultrasound, magnetic resonance image, transvaginal ultrasound, barium enema, and colonoscopy, play significant roles in determining the presence, depth, histology, and other relevant data about the extension of the disease. Diagnostic algorithm depends on the clinical presentation, the expertise of the medical team, and the technology available at each institution. This article reviews and discusses relevant clinical points in endometriosis, including techniques and outcomes of the study of the disease through transrectal ultrasound and fine-needle aspiration.

Keywords: endometriosis; endoscopic ultrasonography; fine-needle aspiration.

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Figures

Figure 1
Figure 1
Macroscopic aspect of intestinal endometriosis (segmentectomy of the sigmoid).
Figure 2
Figure 2
Endometriotic infiltrating lesion in the intestinal wall (TRUS). TRUS: transrectal ultrasound.
Figure 3
Figure 3
Endometriotic infiltrating lesion in the intestinal wall (MRI). MRI: magnetic resonance imaging.
Figure 4
Figure 4
Endometriotic infiltrating lesion in the intestinal wall (TVUS). TVUS: transvaginal ultrasound.
Figure 5
Figure 5
Endometriotic infiltrating lesion in the intestinal wall (Barium enema).
Figure 6
Figure 6
Endometriotic infiltrating lesion in the intestinal wall (colonoscopy).
Figure 7
Figure 7
Hitachi Rigid Linear Probe (EUP U 33) used in the study for intestinal endosonography.
Figure 8
Figure 8
TRUS – right iliac vessels. TRUS: transrectal ultrasound.
Figure 9
Figure 9
TRUS – vena cava, aorta, and spine (Hitachi biplane probe). TRUS: transrectal ultrasound.
Figure 10
Figure 10
TRUS – hypoechogenic and heterogeneous lesions infiltrating the intestinal wall. TRUS: transrectal ultrasound.
Figure 11
Figure 11
Echo-logic schematic classification of the depth of intestinal infiltration (ueT1-T5).
Figure 12
Figure 12
Echo-logic schematic classification according to pelvic site (ueL1-L5).
Figure 13
Figure 13
Endometriotic lesion ueT1 (TRUS). TRUS: transrectal ultrasound.
Figure 14
Figure 14
Endometriotic lesion ueT2 (TRUS). TRUS: transrectal ultrasound.
Figure 15
Figure 15
Endometriotic lesion ueT3 (TRUS). TRUS: transrectal ultrasound.
Figure 16
Figure 16
Endometriotic lesion ueT4 (TRUS). TRUS: transrectal ultrasound.
Figure 17
Figure 17
Endometriotic lesion ueT5 (TRUS). TRUS: transrectal ultrasound.
Figure 18
Figure 18
Rigid Probe Hitachi EUP V-33 and DCHN-22-20 needle used in the study for TRUS-FNA. FNA: fine-needle aspiration.
Figure 19
Figure 19
Intestinal endosonography showing the needle introduced within the intestinal lesion.
Figure 20
Figure 20
Material collected via FNA into the vial of 10% formaldehyde. FNA: fine-needle aspiration.
Figure 21
Figure 21
Histological image of the material obtained via FNA highlighting glandular pattern. FNA: fine-needle aspiration.
Figure 22
Figure 22
Histological image of the material obtained via FNA highlighting stromal pattern. FNA: fine-needle aspiration.
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