title: Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography.
abstract: BACKGROUND
  To evaluate the usefulness of transvaginal and transrectal ultrasonography for diagnosis and management of deeply infiltrating rectosigmoid endometriosis.
  
  
  METHODS
  A series of six patients (aged 32-39 years) with rectosigmoid endometriosis underwent transvaginal and transrectal ultrasonography. In three patients undergoing surgical resection of the intestine, the ultrasonographic findings were compared with macroscopic and microscopic findings. In one patient, sequential observations of the lesion using ultrasonography were conducted before and after medical treatment and following childbirth.
  
  
  RESULTS
  In all cases, the lesion was detected as a hypoechoic irregular-shaped area surrounded by a hyperechoic rim located posterior to the uterus, with size ranging from 18 x 17 to 29 x 28 mm in diameter. The comparison of the ultrasonographical findings with histology revealed that the hypoechoic irregular-shaped area corresponded to a layer of hypertrophic muscularis propria of the lesion, while the hyperechoic rim represented the layer including the mucosa, submucosa and serosa. In one patient, the lesion decreased in size and lost its central hypoechoic area after childbirth in association with pain relief.
  
  
  CONCLUSIONS
  Transvaginal and transrectal ultrasonography provides characteristic appearances for rectosigmoid endometriosis that correlate well with its histological findings. The procedures would be useful in the management of rectosigmoid endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Koga
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osuga
authors.forename: Tetsu
authors.initials: T
authors.lastname: Yano
authors.forename: Mikio
authors.initials: M
authors.lastname: Momoeda
authors.forename: Osamu
authors.initials: O
authors.lastname: Yoshino
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Hirota
authors.forename: Koji
authors.initials: K
authors.lastname: Kugu
authors.forename: Osamu
authors.initials: O
authors.lastname: Nishii
authors.forename: Osamu
authors.initials: O
authors.lastname: Tsutsumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Taketani
mesh_terms: D000328:Adult; D003113:Colonoscopy; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D012002:Rectal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography