Open AccessTransrectal ultrasound and the diagnosis of rectovaginal endometriosis: a prospective observational study
Author(s) -
GRIFFITHS ANTHONY,
KOUTSOURIDOU ROXANI,
VAUGHAN SUE,
PENKETH RICHARD,
ASHLEY ROBERTS S.,
TORKINGTON JARED
Publication year - 2008
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1080/00016340801948318
Subject(s) - medicine , endometriosis , laparoscopy , gynecology , surgery
Background . Rectovaginal endometriosis is a severe form of pelvic endometriosis in which pharmacological treatment is relatively ineffective (Vercellini et al., Fertil Steril. 2005;84:1375–87). Laparoscopic surgical treatment is effective, but has the potential risks of bowel perforation and colostomy formation (Darai et al., Am J Obstet Gynecol. 2005;192:394–400). Transrectal ultrasound scanning can be applied as a preoperative tool to predict the presence of rectovaginal endometriosis and bowel wall involvement (Abrao et al., J Am Assoc Gynecol Laparosc. 2004;11:50–4). Methods . Thirty‐two women underwent transrectal ultrasound followed by therapeutic laparoscopy. Likelihood ratios and post‐test prevalences were calculated with Fagan's normogram. This was then extrapolated with the aid of a mathematical model to a low‐risk population. Results . A positive likelihood ratio was found to be 10.89 (95% confidence ratio (CI): 1.62–73.15) and a negative likelihood ratio was found to be 0.24 (95% CI: 0.1–0.57). The pre‐test prevalence of rectovaginal endometriosis was 56%. The positive post‐test prevalence probability was 93%, and the negative post‐test prevalence probability was 23%. Conclusion . Preoperative transrectal ultrasound scanning for rectovaginal endometriosis is an extremely accurate predictive test, and strongly predicts the need for extensive laparoscopic dissection and potential bowel resection.