ArticlePublisher preview available

Is pelvic MRI in women presenting with pelvic endometriosis suggestive of associated ileal, appendicular, or cecal involvement?

Authors:
Hélène Gimonet at Centre Hospitalier Universitaire de Nantes
Hélène Gimonet
Valérie Laigle-Quérat
Valérie Laigle-Quérat
Valérie Laigle-Quérat
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Stéphane Ploteau at Centre Hospitalier Universitaire de Nantes
Stéphane Ploteau
Cergika Veluppillai
Cergika Veluppillai
Cergika Veluppillai
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Show all 6 authorsHide
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Purpose: To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. Methods: Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. Results: Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98-42.19), 5.8 (95% CI 1.12-30.07), and 6.74 (95% CI 1.23-36.77), respectively. Conclusions: Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.
Figures - available from: Abdominal Radiology
This content is subject to copyright. Terms and conditions apply.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Abdominal Radiology
This content is subject to copyright. Terms and conditions apply.
Is pelvic MRI in women presenting with pelvic
endometriosis suggestive of associated ileal,
appendicular, or cecal involvement?
He
´le
`ne Gimonet ,
1
Vale
´rie Laigle-Que
´rat,
1
Ste
´phane Ploteau,
2
Cergika Veluppillai,
2
Brice Lecle
`re,
3
Eric Frampas
1
1
Service de radiologie et imagerie me
´dicale, Hoˆ tel-Dieu, CHU de Nantes, 1 place Alexis-Ricordeau, 44093 Nantes, France
2
Service de gyne
´cologie-obste
´trique, Hoˆ pital Femme-enfant-adolescent, CHU de Nantes, 38 boulevard Jean-Monnet, 44093 Nantes,
France
3
Service d’e
´valuation me
´dicale et d’e
´pide
´miologie, Hoˆ pital St Jacques, CHU de Nantes, 85 rue St Jacques, 44093 Nantes, France
Abstract
Purpose: To evaluate whether deep pelvic endometriosis
or endometriomas diagnosed at pelvic MRI are associ-
ated with extrapelvic bowel endometriosis (EPBE) (ileal,
appendicular, or cecal involvement) in order to suggest
criteria for performing an additional imaging examina-
tion dedicated to the assessment of EPBE.
Methods: Ninety-six patients operated on for deep pelvic
endometriosis were retrospectively included. They were
classified in two groups according to the presence of
surgically and histologically proven EPBE. According to
pelvic endometriotic lesions described on the preopera-
tive pelvic MRI, a logistic regression analysis was
performed to evaluate a possible association between
EPBE and pelvic endometriosis.
Results: Eleven patients had EPBE (5 appendicular, 2
cecal, and 4 ileocecal lesions) at surgery. In adjusted
models, involvement of the right ureter, rectosigmoid,
and sigmoid localizations were statistically associated
with EPBE with adjusted OR of 9.13 (95%CI
1.98–42.19), 5.8 (95%CI 1.12–30.07), and 6.74 (95%CI
1.23–36.77), respectively.
Conclusions: Further imaging evaluation to assess ileal,
appendicular, or cecal endometriosis should be proposed
in case of sigmoid or rectosigmoid endometriosis diag-
nosed at pelvic MRI. A right ureteral lesion diagnosed
preoperatively should be considered carefully as its
association with EPBE is not described so far.
Key words: Magnetic resonance imaging—Deep
infiltrating endometriosis—Bowel—Sigmoid—Ileocecal
Endometriosis is an estrogen-dependent disease that af-
fects more than 10%of reproductive-age women. It is
characterized by development of endometrial-like tissue
outside of the uterine cavity and is commonly associated
with chronic pelvic pain and infertility. Deep infiltrating
endometriosis is associated with more severe symptoms
(dysmenorrhea, dyspareunia, dyschesia, meno- and
metrorrhagia, dysuria…)[1–3].
One of the most serious associated sites of
endometriosis is the intestinal tract, which occurs in
22%–56%of women with deep pelvic endometriosis [4–
6], and may manifest with cramping abdominal pain,
diarrhea, constipation, nausea, vomiting, bloating, and
symptoms suggestive of bowel occlusion. Bowel
endometriosis affects the rectum and sigmoid in 31%–
56%of cases [4,5,7]. Less frequent sites are caecum,
distal ileum, and appendix defined as extrapelvic bowel
endometriosis (EPBE) which are found in 4.1%–10.7%,
4.7%–2.7%, and 6.4%–10.7%of women with deep infil-
trating endometriosis, respectively. Bowel endometriosis
is reported to be multifocal in one third of the cases, and
one fourth of the pelvic bowel endometriosis are associ-
ated with EPBE [4]. Surgical treatment of deep infiltrat-
ing endometriosis, particularly when the rectosigmoid
is involved, entails a risk of complication such as recto-
vaginal fistula, pelvic abscess, and transient urinary
retention or dysuria [8–10]. However, a complete resection
of all endometriotic implants offers the best long-term
symptomatic relief. The balance between the benefits and
Correspondence to: He
´le
`ne Gimonet; email: helene.gimonet@hotmail.fr
ª
Springer Science+Business Media New York 2016
Published online: 3 September 2016
Abdominal
Radiology
Abdom Radiol (2016) 41:2404–2410
DOI: 10.1007/s00261-016-0884-7
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... (DIE) is one phenotype of endometriosis, which is defined by an extension of endometrial tissue-like under the peritoneal surface, usually >5 mm and/or nodular and able to invade adjacent structures, associated with fibrosis [2]. DIE can affect all pelvic compartments and can be associated with bowel involvement [3,4]. The distribution of the involvement of the different bowel segments is uneven. ...
... Although rare, extrapelvic involvement by DIE is a serious concern as it may require more extensive bowel resection that was not anticipated preoperatively [3,4,15,16]. In addition, endometriosis nodules that involve the appendix, cecum, or distal ileum are hard to detect with pelvic MRI because they are located above the upper slices of the MRI scan [4]. ...
... Although rare, extrapelvic involvement by DIE is a serious concern as it may require more extensive bowel resection that was not anticipated preoperatively [3,4,15,16]. In addition, endometriosis nodules that involve the appendix, cecum, or distal ileum are hard to detect with pelvic MRI because they are located above the upper slices of the MRI scan [4]. Gimonet et al. suggested that further specific imaging evaluation should be performed to identify ileal, appendicular or cecal endometriosis in women with sigmoid or rectosigmoid DIE [4]. ...
Comparison between CT-enterography and MR-enterography for the diagnosis of right-sided deep infiltrating endometriosis of the bowel
Article
  • Feb 2023
Objective: To compare computed tomography-enterography (CTE) and magnetic resonance-enterography (MRE) in the detection of right-sided bowel deep infiltrating endometriosis (DIE). Materials and methods: Fifty women with DIE who underwent preoperatively CTE and MRE were included. CTE and MRE were first analyzed separately by two independent readers who analyzed five bowel segments (cecum, appendix, ileocecal junction, distal ileum and proximal small bowel [i.e., proximal ileum and jejunum]) for the presence of DIE and then interpreted in consensus. CTE, MRE and CTE with MRE were compared in terms of sensitivity, specificity and accuracy. Interobserver agreement was assessed with kappa (κ) test. Results: Using the reference standard 25 out 250 bowel segments were involved by DIE in 18 women and 225 were free of DIE. Sensitivity, specificity, and accuracy of CTE were 60% (95% confidence interval [CI]: 39-79), 93% (95% CI: 89-96) and 90% (95% CI: 85-93) for Reader 1, respectively, and 52% (95% CI: 31-72), 99% (95% CI: 97-100) and 94% (95% CI: 91-97) for Reader 2, with no differences in sensitivity (P = 0.564) and specificity (P = 0.181) between readers and fair interobserver agreement (κ = 0.37). For MRE these figures were 52% (95% CI: 31-72), 92% (95% CI: 88-95) and 88% (95% CI: 84-92) for Reader 1 and 60% (95% CI: 39-79), 99% (95% CI: 96-100) and 95% (95% CI: 91-97) for Reader 2, with no differences in sensitivity (P = 0.157) and specificity (P = 0.061) between readers and fair interobserver agreement (κ = 0.31). Significant differences in sensitivity (20%; 95% CI: 7-41) were found between CTE + MRE vs. CTE alone for Reader 1 and vs. MRE alone for Reader 2 (P = 0.041 for both) CONCLUSION: CTE and MRE have not different sensitivities and convey only fair interobserver agreement but are highly specific for the diagnosis of right-sided bowel DIE. CTE and MRE are complementary because they improve the detection of DIE implants when used in combination.
View
... However, if performed, T2-weighted sequences depict a hypointense retractile mass or nodular thickening of the appendix. Involvement of the appendix can also be contiguous to fibrotic implants of the ovarian fossa [70,71] (Fig. 7). ...
... In clinical practice, when appendiceal endometriosis is isolated without pelvic implants, the diagnosis is not performed by imaging [7,71]. Conversely, the diagnosis may be evoked when features of deep endometriosis coexist with appendiceal findings on imaging. ...
Acute abdominal pain in women of reproductive age: keys to suggest a complication of endometriosis
Article
Full-text available
  • May 2023
Although endometriosis is a common gynecological condition in women of reproductive age, a complication of endometriosis is rarely considered as the differential diagnosis of acute abdominal pain in that context. However, acute events in women with endometriosis can represent life-threatening conditions, which require emergent treatment and often surgical management. Mass effect of endometriotic implants can give rise to obstructive complications, specifically occurring in the bowel or in the urinary tract, while inflammatory mediators released by ectopic endometrial tissue can lead to inflammation of the surrounding tissues or to superinfection of the endometriotic implants. Magnetic resonance imaging is the best imaging modality to reach the diagnosis of endometriosis, but an accurate diagnosis is possible on computed tomography, especially in the presence of stellar, mildly enhanced, infiltrative lesions in suggestive areas. The aim of this pictorial review is to provide an image-based overview of key findings for the diagnosis of acute abdominal complications of endometriosis. Graphical Abstract
View
... Among extragenital sites of disease, the bowel is the most common with a prevalence range of 3.8-37%, mainly affecting the rectum and the sigmoid colon [5,6]. ...
Endometriosis of the appendix: prevalence, associated lesions, and proposal of pathogenetic hypotheses. A retrospective cohort study with prospectively collected data
Article
Full-text available
  • Aug 2024
  • ARCH GYNECOL OBSTET
Objective To assess the prevalence of endometriosis of the appendix and the association with other pelvic localizations of the disease and to provide pathogenesis hypotheses. Methods Monocentric, observational, retrospective, cohort study. Patients undergoing laparoscopic endometriosis surgery in our tertiary referral center were consecutively enrolled. The prevalence of the different localizations of pelvic endometriosis including appendix involvement detected during surgery was collected. Included patients were divided into two groups based on the presence of appendiceal endometriosis. Women with a history of appendectomy were excluded. Measurements and main results. Four hundred-sixty patients were included for data analysis. The prevalence of appendiceal endometriosis was 2.8%. In patients affected by endometriosis of the appendix, concomitant ovarian and/or bladder endometriosis were more frequently encountered, with prevalence of 53.9% (vs 21.0% in non-appendiceal endometriosis group, p = 0.005) and 38.4% (vs 11.4%, p = 0.003), respectively. Isolated ovarian endometriosis was significantly associated to appendiceal disease compared to isolated uterosacral ligament (USL) endometriosis or USL and ovarian endometriosis combined (46.2% vs 15.4% vs 7.7%, p < 0.001). Poisson regression analysis revealed a 4.1-fold and 4.4-fold higher risk of ovarian and bladder endometriosis, respectively, and a 0.1-fold risk of concomitant USL endometriosis in patients with appendiceal involvement. Conclusion Involvement of the appendix is not uncommon among patients undergoing endometriosis surgery. Significant association was detected between appendiceal, ovarian, and bladder endometriosis that may be explained by disease dissemination coming from endometrioma fluid shedding. Given the prevalence of appendiceal involvement, counseling regarding the potential need for appendectomy during endometriosis surgery should be considered.
View
... Specifically, of the 37 women who underwent computerised tomography (CT), an ileal lesion was suspected in only 3 (8%) of them. Rousset et al. (2014) diagnosed all 6 cases of ileocaecal endometriotic lesions using 3.0-Tesla (T) MRI enterography; conversely, in Gimonet et al. (2016) no ileal lesion were found using MRI in 6 patients. A preoperative diagnosis of ileal endometriosis was suspected in one (3%) of 33 women who had double contrast barium enema (BDCE) and in one of the 9 women (11%) who underwent colonoscopy. ...
Diagnosis and treatment of uncommon ileal endometriosis: a case report and literature review
Article
Full-text available
  • Dec 2021
Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It is a common finding in premenopausal women and commonly affects the gastrointestinal tract, especially the rectosigmoid tract. Small bowel involvement is rare and usually asymptomatic making diagnosis difficult. Here we report an uncommon case of exophytic ileal endometriosis surgically treated. Detailed pre-operative counselling on the risk of ileal surgery should always be considered in all cases with endometriosis requiring surgery. We also present a review of the literature regarding the clinical presentation, diagnosis, and treatment of this challenging condition.
View
... As mentioned above, intestinal endometriosis refers to the rectum and sigmoid endometriosis. However, there are a special intestinal endometriosis, appendiceal endometriosis, which is considered as an uncommon finding, in the literature its prevalence varies widely [26]. In our study, there are 4 patients with appendiceal endometriosis , are responsible for approximately 4% of all intestinal lesions. ...
Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study
Article
Full-text available
Background: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods: The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and > 50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results: DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n = 184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n = 120 patients; 2.76 ± 1.52 vs. 2.33 ± 1.34; P = 0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P < 0.01) and vaginal (17.4% vs. 6.7%; P < 0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83 ± 1.56 vs. 2.74 ± 1.53; P = 0.678; and 2.65 ± 1.42 vs. 2.80 ± 1.43; P = 0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and > 50 mm. Conclusion: Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
View
... Ileal involvement is described in 4.1-16.9% of the patients with multi-segmental small bowel involvement, and in up to 55% of patients that have rectal implants [9,28]. Detection of small bowel endometriosis can be particularly difficult on routine pelvic MRI exams intended to stage pelvic organ involvement due to the small field of view [27,29]. Therefore, in addition to a high degree of suspicion and focused attention to the right lower quadrant on a pelvic MRI, including additional sequences such as large field of view coronal T1 and T2-weighted sequences would help screen for small bowel involvement. ...
Imaging of gastrointestinal endometriosis: what the radiologist should know
Article
Full-text available
  • Jun 2020
Deep invasive gastrointestinal endometriosis (DIGIE) is a frequent and severe presentation of endometriosis. Although most cases invade the rectosigmoid colon, DIGIE can involve any portion of the gastrointestinal tract from the stomach to the rectum, and is commonly multifocal and multicentric. Although histopathologic confirmation with surgery remains the gold standard for diagnosis, ultrasound (US) and magnetic resonance imaging (MRI) are the key non-invasive imaging modalities for initial assessment. US may be preferred as a screening study because of its easy availability and low-cost. Pelvic MRI and magnetic resonance enterography (MRE) provide substantial advantages for disease mapping in the pre-operative period, particularly in extensive bowel endometriosis. Although medical management of DIGIE with hormonal therapy can help control symptoms, disease course can be relentless and require surgical intervention. Surgical options depend on, the location; length; depth; circumference; multicentric or multifocal disease. With procedures including simple excision, fulguration of superficial lesions, shaving, disc excision, and segmental resection. A successful treatment outcome is largely dependent on good communication between the treating surgeon and the radiologist, who can provide vital information for effective surgical planning by reporting the key elements that we elaborate upon in this paper.
View
... However, there are a special intestinal endometriosis, appendiceal endometriosis, which is considered as an uncommon finding, in the literature its prevalence varies widely [26]. In our study, there are 4 patients with appendiceal endometriosis are responsible for approximately 4% of all intestinal lesions. ...
Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study
Preprint
Full-text available
  • Mar 2020
Background: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods: The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and >50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results: DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n=184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n=120 patients; 2.76±1.52 vs. 2.33±1.34; P=0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P<0.01) and vaginal (17.4% vs. 6.7%; P<0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83±1.56 vs. 2.74±1.53; P=0.678; and 2.65±1.42 vs. 2.80±1.43; P=0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and >50 mm. Conclusion: Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe. Key Words: ovarian endometrioma, deep infiltrating endometriosis, lesion distribution characteristics
View
... Some specialty centers and societies outside the United States (US), including those in South America and Europe, advocate for the utilization of bowel preparation prior to pelvic MRI in an effort to increase accuracy of implant detection ( Fig. 1) [20,[32][33][34][35]. Of the institutions participating in the survey, only one denoted routine bowel preparation utilization. ...
Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel
Article
Full-text available
  • Jun 2020
Endometriosis is a common entity causing chronic pain and infertility in women. The gold standard method for diagnosis is diagnostic laparoscopy, which is invasive and costly. MRI has shown promise in its ability to diagnose endometriosis and its efficacy for preoperative planning. The Society of Abdominal Radiology established a Disease-Focused Panel (DFP) to improve patient care for patients with endometriosis. In this article, the DFP performs a literature review and uses its own experience to provide technical recommendations on optimizing MRI Pelvis for the evaluation of endometriosis.
View
View
Hepatocarcinoma en hígado no cirrótico: serie bicéntrica de 19 casos
Article
Full-text available
  • Dec 2019
  • Rev Argent Cir
Background: Hepatocellular carcinoma is the most common type of primary liver cancer and is the third cause of cancer related deaths; 80% of the HCC are associated with cirrhotic livers or chronic liver diseases, which constitute the main risk factor. Chronic inflammation, necrosis and regeneration due to these conditions produce genetic mutation and development of tumor cells. Yet, 10% develop in non-cirrhotic healthy livers without precipitating factors. Material and methods: We conducted a retrospective analysis of the characteristics and survival of patients with diagnosis of hepatocellular carcinoma in non-cirrhotic liver and absence of a history of liver cirrhosis or chronic liver disease undergoing surgery in two hepato-pancreato-biliary units between January 2007 and January 2016. Results: Mean age was 65 years and 13 patients were men. Abdominal pain was the most common clinical presentation. Liver panel was normal in 60% of the cases and alpha-fetoprotein was elevated in only 16%. The diagnosis was made by imaging tests in 61% of the cases. Mean tumor size was 110.6 cm. All the patients underwent surgery. Complications were observed in 36.8% of the patients and survival at 5 years was 62.3%. Conclusion: hepatocellular carcinoma is usually diagnosed as a large lesion in imaging tests ordered due to abdominal pain. Surgery provides curative treatment, and large resections can be safely performed, with low perioperative morbidity and mortality and low incidence of postoperative liver failure,since the liver remnant is healthy and liver function is maintained.
View
Bowel Endometriosis: Preoperative Diagnostic Accuracy of 3.0-T MR Enterography-Initial Results
Article
Full-text available
  • May 2014
  • RADIOLOGY
Purpose: To prospectively determine the accuracy of 3.0-T magnetic resonance (MR) enterography in the preoperative assessment of deep infiltrating endometriosis (DIE) lesions located in the bowel above the rectosigmoid junction. Materials and methods: Institutional review board approval for this study was obtained, and each patient gave written informed consent. Over 18 months, patients with known pelvic DIE who were scheduled for surgery were recruited. Consecutive patients suspected of having bowel endometriosis above the rectosigmoid junction underwent 3.0-T MR enterography. Two blinded readers independently performed a systematic analysis of nine bowel segments above the rectosigmoid junction. MR images were compared with surgical and pathologic findings. Efficacy parameters were calculated with 95% confidence intervals (CIs). Interobserver agreement was assessed with κ statistics. Results: Among the 43 patients enrolled in this study, 33 underwent surgery and were included in the final analyses. Sixteen (48%) patients had bowel DIE lesions located above the rectosigmoid junction at surgery and histopathologic examination. Twenty-six lesions were analyzed, including four ileal, two ileocecal, three cecal, three appendicular, and 14 sigmoid colon lesions. For the diagnosis of these lesions, MR imaging showed sensitivities of 92% (95% confidence interval [CI]: 81.7, 100) for reader 1 and 96% (95% CI: 87.1, 100) for reader 2 and specificities of 100% (95% CI: 98.8, 100) for both readers. The κ value was 0.97. Conclusion: These results show 3.0-T MR enterography is accurate in the preoperative diagnosis and mapping of bowel DIE lesions located above the rectosigmoid junction. Online supplemental material is available for this article.
View
Deep pelvic endometriosis: Accuracy of pelvic MRI completed by MR colonography
Article
Full-text available
  • Jun 2012
  • RADIOL MED
Purpose: This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery. Materials and methods: A total of 143 patients (mean age 34.3 ± 5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3-10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard. Results: Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67-100%, 85-100%, 83-100%, 84-100% and 84-100%, respectively, in recognising lesions located in different pelvic sites. Conclusions: MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.
View
Laparoscopic ileocecal resection for bowel endometriosis
Article
Full-text available
  • Apr 2011
  • SURG ENDOSC
Ileocecal endometriosis is a very rare entity, and its diagnosis is usually made during surgery for other endometriosis sites or, rarely, because of direct complications of ileal involvement. This study was designed to analyze perioperative and long-term outcomes after bowel resection for ileocecal endometriosis. All patients who underwent surgery for ileocecal endometriosis between October 2004 and January 2008 were prospectively collected and analyzed. Thirty-one women (median age, 34 (range, 25-40) years) were identified. Ileocecal endometriosis was diagnosed during surgery in all patients, and it was associated with colorectal endometriosis in 29 patients (94%). All patients underwent laparoscopic ileocecal resection with no laparotomic conversion. Rectosigmoid or rectal resections was associated in 28 patients (90%) and nodulectomy for sigmoid endometriosis in 1 patient. Median duration of surgery was 301 (range, 90-480) min. Other associated surgical procedures included total hysterectomy (n = 3, 14%), ureterolysis (n = 7, 23%), excision of vesical (n = 4, 13%), vaginal (n = 8, 26%), and parametrial (n = 3, 14%) nodules. There was no mortality. Four patients (13%) required blood transfusions and one a reoperation for bleeding. In a patient who performed ureterolysis, a ureteral fistula occurred. The median hospital stay was 7 (range, 5-18) days. Long-term (>12 months) follow-up data were available for 18 patients. After a median follow-up of 27 months, in 12 of 18 patients (67%) defecation after surgery was normal. Only one patient developed recurrence, which is under medical treatment. Laparoscopic ileocecal resection is safe and feasible and should be considered as part of surgery for endometriosis with radical intent.
View
View
Ileocecal endometriosis: Clinical and pathogenetic implications of an underdiagnosed condition
Article
  • Jan 2014
To review our experience with surgical treatment of ileocecal endometriosis. Observational study. Tertiary university hospital in Italy. Eight consecutive patients with infiltrating ileocecal endometriosis operated on between 2003 and 2005. All of the women underwent laparotomic ileocecal or cecal resection and had radical treatment of rectovaginal endometriosis as well. Long-term relief of pelvic pain, constipation, and dyschezia. There were no postoperative intestinal complications. At a mean ± SD follow-up of 106 ± 10 months, all of the patients reported significant improvement of pelvic pain and bowel symptoms. Infiltrating ileocecal endometriosis requiring bowel resection was associated in all cases with infiltrating rectovaginal endometriosis, possibly reflecting a common pathogenesis. A thorough clinical evaluation of women with rectovaginal endometriosis might allow an improvement in the difficult preoperative diagnosis of ileocecal endometriosis. Our data support the long-term efficacy of the radical surgical resection of associated ileocecal and rectovaginal endometriotic lesions in reducing pelvic pain, constipation, and dyschezia.
View
Multislice computed tomography with colon water distension (MSCT-c) in the study of intestinal and ureteral endometriosis
Article
  • Sep 2013
This study evaluates retrospectively the accuracy and reproducibility of multislice computed tomgraphy with colon water distension (MSCT-c) in diagnosing bowel (BE) and ureteral (UE) endometriosis. Sixty-four patients underwent MSCT-c and videolaparoscopic surgery. Two radiologists reviewed MSCT-c examinations: sensitivity and specificity were calculated, considering histological exam as reference standard. In the BE cases, the degree of bowel wall infiltration was also assessed. Sensitivity and specificity for both readers were 100% and 97.6% for BE and 72.2% and100% for UE; the interobserver agreement was excellent. The degree of bowel wall involvement was correctly defined in 90.9% of cases. MSCT-c is an accurate and reproducible technique but-considering the age of the patients-delivers a nonnegligible radiation dose.
View
Résection cœlioscopique du colon-rectum pour endométriose : résultats préliminaires
Article
  • Nov 2004
  • Fuel Energ Abstr
Objective Colorectal endometriosis is source of chronic pelvic pain greatly affecting quality-of-life. Colorectal resection is indicated after failure of medical treatment. Few data are available on complications and functional results after laparoscopic colorectal resection for endometriosis. Therefore, the aims of this prospective study were to evaluate the feasibility, peri-operative complications and functional results of laparoscopic colorectal resection for endometriosis. Materials and Methods From March 2001 to March 2003, 32 consecutive women with clinically-suspected colorectal endometriosis confirmed by MR imaging and rectal endoscopic sonography were included in this prospective study. Results Conversion to open surgery was required for four of the 32 women (12.5%). Mean operating time was 6 hours (range 4 to 13). Associated surgical procedures were: adhesiolysis (n=24), ureteral lysis (n=19), ovarian cystectomy (n=11), and hysterectomy (n=4). Mean blood loss was 2.4g/dl (range: 0 to 8.6). Blood transfusion was required in 6 women including two who underwent laparoconversion. Two rectovaginal fistulae (6.3%) occurred requiring a colostomy. Urinary retention was noted in 6 women (15.6%). Conclusion Laparoscopic colorectal resection for endometriosis is feasible and is associated with a significant improvement of symptoms. However, the benefit of this procedure has to be weighed against the high morbidity.
View
A language and environment for statistical computing
Article
  • Jan 2006
  • COMPUTING
Herbivore damage is generally detrimental to plant fitness, and the evolu- tionary response of plant populations to damage can involve either increased resistance or increased tolerance. While characters that contribute to resistance, such as secondary chem- icals and trichomes, are relatively well understood, characters that contribute to a plant's ability to tolerate damage have received much less attention. Using Helianthus annuus (wild sunflower) and simulated damage of Haplorhynchites aeneus (head-clipping weevil) as a model system, we examined morphological characters and developmental processes that contribute to compensatory ability. We performed a factorial experiment that included three levels of damage (none, the first two, or the first four inflorescences were clipped with scissors) and eight sires each mated to four dams. We found that plants compensated fully for simulated head-clipper damage and that there was no variation among plant families in compensatory ability: seed production and mean seed mass did not vary among treat- ments, and sire X treatment interactions were not significant. Plants used four mechanisms to compensate for damage: (1) Clipped plants produced significantly more inflorescences than unclipped plants. Plants produced these additional inflorescences on higher order branches at the end of the flowering season. (2) Clipped plants filled significantly more seeds in their remaining heads than did unclipped plants. (3) Clipped plants, because they effectively flowered later than unclipped plants, were less susceptible to damage by seed- feeding herbivores other than Haplorhynchites. (4) In later heads, seed size was greater on clipped plants, which allowed mean seed size to be maintained in clipped plants. Although there was genetic variation among the families used in this experiment for most of the characters associated with compensation for damage (seed number, mean seed size, mean flowering date, length of the flowering period, and branching morphology), in analyses of these characters, no sire X treatment interactions were significant indicating that all of the families relied on similar mechanisms to compensate for damage.
View
MDCT Enteroclysis Urography With Split-Bolus Technique Provides Information on Ureteral Involvement in Patients With Suspected Bowel Endometriosis
Article
  • May 2011
  • AM J ROENTGENOL
The objective of our study was to evaluate the accuracy of MDCT enteroclysis with a split-bolus technique in detecting ureteral compression caused by endometriosis in women with suspected bowel endometriosis. This prospective study included 103 patients with suspected bowel endometriosis. Examinations were performed on a 16-MDCT scanner; 20% of the IV contrast material was administered during colonic distention and intestinal hypotonization (i.e., 7-8 minutes before starting volumetric acquisition). After injection of the remaining quantity of contrast material, the volumetric acquisition was performed during the portal phase of contrast enhancement. The sensitivity of MDCT enteroclysis urography in identifying bowel nodules was 95.5%; specificity, 97.2%; positive predictive value (PPV), 98.5%; negative predictive value (NPV), 92.1%; accuracy, 96.1%; positive likelihood ratio, 34.39; and negative likelihood ratio, 0.05. The opacification was poor in 8.2% of the ureters, sufficient in 17.4%, and good in 74.4%. One hundred ninety-one ureters (92.3%) were opacified between the crossing of the iliac vessels and the bladder. Compression was observed at MDCT enteroclysis urography in 36 ureters (17.4%); surgery confirmed the presence of ureteral compression in 34 ureters (16.4%). The sensitivity of MDCT enteroclysis urography in identifying ureteral compression was 97.1%; specificity, 98.8%; PPV, 94.4%; NPV, 99.4%; accuracy, 99.0%; positive likelihood ratio, 83.54; and negative likelihood ratio, 0.03. MDCT enteroclysis urography allows radiologists to determine whether bowel endometriosis and ureteral compression are present without increasing the radiation dose imparted to the patient.
View
Complications after surgery for deeply infiltrating pelvic endometriosis
Article
  • Nov 2010
  • BJOG-INT J OBSTET GY
to evaluate the complications after surgery for deep endometriosis. retrospective study. data from the CHU Estaing database and patients' charts between January 1987 and December 2007. all women given surgical treatment for deep endometriosis. women who underwent surgery for deep endometriosis were reviewed for intra- and postoperative complications. primary outcomes were rates of intra- and postoperative complications. Complications were compared according to the procedure performed. a total of 568 women were included in the study, with a mean age of 32.4 years. The mean estimated diameter of the nodule felt by vaginal examination was 1.8 cm (ranging from 0.5 to 7 cm). Laparoscopic surgery was performed in 560 women (98.6%), and conversion was required in 2.3%. The mean operative time was 155 minutes. Intraoperative complications occurred in 12 women (2.1%), including six minor (1.05%) and six major (1.05%) complications. Postoperative complications developed in 79 women (13.9%), including 54 minor (9.5%) and 26 major (4.6%) complications (one woman had both minor and major postoperative complications). The overall major postoperative complication rate for women who underwent any type of rectal surgery (shaving, excision and suture, or segmental resection) was 9.3% (21 out of 226), compared with only 1.5% for the other women (five out of 342) (P <  .01). Shaving presented less major postoperative complications compared with segmental resection (24 versus 6.7%; P = 0.004). surgery for deep endometriosis is feasible, but it is associated with major complications, especially when any type of rectal surgery must be performed.
View