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Deep Pelvic Endometriosis: A Multidisciplinary Approach by Paola De Nardi, Stefano Ferrrari, Elaine Denny

By Paola De Nardi, Stefano Ferrrari, Elaine Denny

Deep pelvic endometriosis is among the so much critical expressions of a affliction which may contain all of the pelvic organs – bladder, ureters, rectosigmoid colon – inflicting debilitating signs and resulting in impaired caliber of existence in younger women.
The chapters conceal either diagnostic and healing facets of this disorder. The vital function of diagnostic imaging in surgical choice making is highlighted, in addition to the problems eager about cautious making plans of surgical procedure, and specific awareness is paid to minimally invasive techniques.
The paramount value of a multidisciplinary group, regarding the services of radiologists, gastroenterologists, and psychologists, in addition to the talents of the gynecologist, urologist, and colorectal health practitioner is underlined during the text.

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De Nardi ( ) Department of Surgery, San Raffaele Scientific Institute, Milan, Italy Deep Pelvic Endometriosis. Paola De Nardi, Stefano Ferrari © Springer-Verlag Italia 2011 47 P. De Nardi, S. Ferrari 48 results in terms of symptom control, although the complexity of the disease or extensive involvement of extragenital organs sometimes requires laparotomy, or carries a high risk of conversion. Data on reoperation for rectovaginal endometriosis and repetitive conservative surgery are scant. 1 Medical Therapy Once the diagnosis of endometriosis has been histologically confirmed, endocrine pharmacotherapy can be used as a neoadjuvant or adjuvant measure, as well as for treatment of recurrences.

In a few patients with large intestinal lesions, colonoscopy may offer the possibility to diagnose an intestinal stenosis or substenosis. The major use of colonoscopy is to histologically distinguish intestinal endometriotic lesions from malignant pathology [29]. 38 2 P. De Nardi, S. 10 Double-contrast Barium Enema Double-contrast barium enema (DCBE) has been applied in the diagnosis of intestinal DIE. DCBE has the great advantage of being easily reproducible and is also less expensive than EUS and MRI [25].

Even with this technique, however, the greatest limitation of TVS is the impossibility of investigating lesions that are proximal to the rectosigmoid junction [41]. 5 “Tenderness-guided” Ultrasonography As an alternative, in 2007 Guerriero et al [42] created a new modality of ultrasonographic evaluation called “tenderness-guided” ultrasonography; using an acoustic window between the transvaginal probe and the surrounding 28 2 P. De Nardi, S. Ferrari vaginal structures by increasing the amount of ultrasound gel inside the probe cover, coupled with an “active” role of the patient, who indicated the site of any tenderness experienced during examination, this method seems to improve the diagnostic accuracy.

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