Keywords:
Outcomes, Outcomes analysis, Diagnostic procedure, Colonography CT, Genital / Reproductive system female, Colon, CT-Colonography
Authors:
E. O'Dwyer1, S. Liddy2, R. Kumar Sarkar3, A. O'Neill3, J. Feeney4; 1 Dublin 24/IE, 2Dublin 24/IE, 3Dublin/IE, 4Dublin, Dublin/IE
DOI:
10.1594/ecr2018/C-2743
Aims and objectives
Endometriosis,
defined as the presence of functional endometrial glands and stroma outside the uterine cavity,
is a common condition with an estimated prevalence of 10-15%.
Deeply infiltrating endometriosis (DIE) is characterised by endometriotic deposits infiltrating into the peritoneum to a depth of > 5mm.
Fig. 1: a.Axial image from CT colonography demonstrating eccentric sigmoid colon due peritoneal deposit and 4.1cm extraluminal left adnexal mass (arrow)confirmed as endometrial deposit at surgery.
b.Corresponding sagittal image demonstrate extraluminal mass and stricture (arrow)
c. and d. Corresponding 3D endoluminal images demonstrate extraluminal mass (arrow).
DIE with colonic involvement was confirmed at surgery.
Approximately 3-37% women with DIE have bowel involvement,
the rectosigmoid being the most common site of involvement.
DIE can be associated with diarrhoea,
rectal bleeding and non-cyclical pelvic pain.
Accurate preoperative evaluation of the location and extent of the colonic lesions allows for precise surgical planning and appropriate preoperative counselling.
Pelvic MRI is considered the optimal non-invasive method for evaluating DIE,
however its utility in assessing colonic involvement is uncertain.
The reference standard for the diagnosis of endometriosis is the laparoscopic visualisation of suspicious lesions,
allowing correct staging of the disease.
However more minimally invasive procedures such as CT colonography may provide a viable alternative.
With our institution,
a tertiary referral centre for DIE,
we carried out a retrospective study which aimed to determine the diagnostic value of CT colonography in evaluating colonic involvement in deeply infiltrating endometriosis and if it is an useful and practical adjunct in pre-operative management.