title: Endoscopic rectal ultrasound and elastosonography are useful in flow chart for the diagnosis of deep pelvic endometriosis with rectal involvement.
abstract: OBJECTIVE
  Endometriosis is defined by the presence of endometrial glands and stroma outside the uterus. The disease causes pelvic pain, dysmenorrhea, dyspareunia, dyschezia and urinary symptoms. The aim of this study was to assess the usefulness of endoscopic ultrasound (EUS) and elastosonography for detecting rectosigmoid endometriosis and to compare the findings, in selected and symptomatic patients, with surgical specimens in order to select the best surgical strategy.
  
  
  METHODS
  Sixty-three consecutive patients (mean age 34.2; range 25-50 years) with diagnosis of endometriosis were referred for rectal endosonography to evaluate the rectal involvement. Patients complained of abdominal pain, rectal bleeding, constipation and dysmenorrhea. Sub-stenosis of the rectosigmoid lumen was found endoscopically in one patient (1.5%), bulging in 21 (33.3%), mucosal hyperemia or edema in one (1.5%), and no lesions in 39 patients (61.9%); no abdominal masses or obstruction were reported. Each woman completed a self-administered 100-point questionnaire to evaluate endometriosis-related pain (intensity of symptoms: 0 = absent, 100 = unbearable). After clinical imaging evaluation, 10 symptomatic patients (mean age 32.2; range 26-45 years) were evaluated for surgery.
  
  
  RESULTS
  EUS detected endometriotic lesions in all patients as a hypoechoic mass, poorly vascularized with irregular, undefined margins. In cases where the rectosigmoid wall was involved, there was invasion of the fourth layer. All patients who were operated had histologic findings of endometriotic lesions involving the rectal wall, as indicated by EUS.
  
  
  CONCLUSIONS
  EUS and elastosonography offers a non-invasive and sensitive technique to better define the endometriotic infiltration in the rectosigmoid wall.
authors.affiliation: Departments of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy. mezzi.gianni@hsr.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Mezzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Paolo Giorgio
authors.initials: PG
authors.lastname: Arcidiacono
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Puppo
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.forename: Pier Alberto
authors.initials: PA
authors.lastname: Testoni
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000000981:diagnostic imaging; D054459:Elasticity Imaging Techniques; D004715:Endometriosis / Q000000981:diagnostic imaging*; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging*; D011351:Proctoscopy / Q000379:methods*; D012002:Rectal Diseases / Q000000981:diagnostic imaging*; D012007:Rectum / Q000000981:diagnostic imaging*; D014591:Uterine Diseases / Q000000981:diagnostic imaging