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Background <p>Endometriosis is a common and challenging gynecological disease that has a great impact on women’s quality of life. Deep infiltrating endometriosis (DIE) involving the bowel poses a significant challenge to the gynecologist. Transvaginal sonography (TVS) is an established first-line imaging tool in the evaluation of the extent of rectosigmoid endometriosis extent before surgery. The aim of this study is to evaluate the ability of preoperative 3D TVS measurements in predicting surgical technique in patients with rectosigmoid DIE. This retrospective study included all consecutive patients who underwent TVS followed by laparoscopic surgery for rectal DIE from October 2021 to February 2024. The length, thickness, and circumference involvement of the rectal nodules were recorded using 2D and 3D TVS for each bowel lesion and compared with postoperative outcomes.</p> Results <p>Fifty-one bowel surgeries were performed: four (7.8%) segmental resections, 18 (35.3%) disc excisions, 28 (54.9%) bowel shavings, and one case (2.0%) of double disc excision for multicentric lesions more than 4&#xa0;cm apart. According to 3D TVS measurements, none of the patients who underwent segmental resection had a length &lt; 3.5&#xa0;cm (3.5–4.9&#xa0;cm), with three out of four having a circumference &gt; 50%. All patients who had shaving or disc excision had a length &lt; 3&#xa0;cm with a mean longitudinal diameter of 2.1&#xa0;cm and 2.9&#xa0;cm, respectively. An average thickness of 4.8&#xa0;mm, 7.8&#xa0;mm, and 9.0&#xa0;mm was observed for nodules that were treated by shaving, disc excision, and segmental resection, respectively. A circumference involvement cutoff value of 50% was appropriate for disc excision. We had 13 (25.4%) cases of rectal DIE without endometriomas and two (3.9%) cases in which the bowel was the only site of DIE involvement. A cutoff value of 3.5&#xa0;cm for lesion length and 8&#xa0;mm for lesion thickness was predictive for segmental bowel resection with an area under the curve (AUC) of 0.959 and 0.908, respectively.</p> Conclusions <p>3D TVS provides an accurate and thorough evaluation of the extent of rectosigmoid endometriosis. Preoperative assessment of the length, thickness, and circumference involvement can help decide whether segmental bowel resection or a conservative approach is required.</p>

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Role of 3D transvaginal ultrasound in predicting surgical technique in patients with rectal deep infiltrating endometriosis

  • 期刊论文

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  • 发表日期：

    2026年6月17日

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  • Samar El-Maadawy,
  • Nesreen Alaaeldin,
  • Charles Nagy,
  • Hebatalla Elkassas

摘要

Background

Endometriosis is a common and challenging gynecological disease that has a great impact on women’s quality of life. Deep infiltrating endometriosis (DIE) involving the bowel poses a significant challenge to the gynecologist. Transvaginal sonography (TVS) is an established first-line imaging tool in the evaluation of the extent of rectosigmoid endometriosis extent before surgery. The aim of this study is to evaluate the ability of preoperative 3D TVS measurements in predicting surgical technique in patients with rectosigmoid DIE. This retrospective study included all consecutive patients who underwent TVS followed by laparoscopic surgery for rectal DIE from October 2021 to February 2024. The length, thickness, and circumference involvement of the rectal nodules were recorded using 2D and 3D TVS for each bowel lesion and compared with postoperative outcomes.

Results

Fifty-one bowel surgeries were performed: four (7.8%) segmental resections, 18 (35.3%) disc excisions, 28 (54.9%) bowel shavings, and one case (2.0%) of double disc excision for multicentric lesions more than 4 cm apart. According to 3D TVS measurements, none of the patients who underwent segmental resection had a length < 3.5 cm (3.5–4.9 cm), with three out of four having a circumference > 50%. All patients who had shaving or disc excision had a length < 3 cm with a mean longitudinal diameter of 2.1 cm and 2.9 cm, respectively. An average thickness of 4.8 mm, 7.8 mm, and 9.0 mm was observed for nodules that were treated by shaving, disc excision, and segmental resection, respectively. A circumference involvement cutoff value of 50% was appropriate for disc excision. We had 13 (25.4%) cases of rectal DIE without endometriomas and two (3.9%) cases in which the bowel was the only site of DIE involvement. A cutoff value of 3.5 cm for lesion length and 8 mm for lesion thickness was predictive for segmental bowel resection with an area under the curve (AUC) of 0.959 and 0.908, respectively.

Conclusions

3D TVS provides an accurate and thorough evaluation of the extent of rectosigmoid endometriosis. Preoperative assessment of the length, thickness, and circumference involvement can help decide whether segmental bowel resection or a conservative approach is required.