Endometriosis is a common medical condition that affects about 10% of women. It is estimated that 7 million women in the US and over 175 million women worldwide suffer from endometriosis.
Endometrial tissue is what makes up the lining of the uterus and what is shed every month during menstruation. Endometriosis is a condition when endometrial tissue implants outside of the uterus. During a period this tissue breaks down, causing periods to be extremely painful and leads to chronic inflammation, adhesions and possibly infertility.
Endometriosis typically implants on the surface of pelvic tissues and organs, called Superficial Endometriosis, which can cause severe symptoms. Superficial endometriosis can be readily seen during laparoscopic surgery; however, it is not easily seen by ultrasound imaging. Deep Infiltrating Endometriosis occurs when superficial implants extend beneath the surface of organs and grow into the underlying tissue, forming nodules. The nodules can be challenging to identify during surgery but can be detected by ultrasound when performed by experienced examiners who are trained in specialized techniques and protocols. Infiltrating endometriosis most commonly affects the rectum, bowel, uterine ligaments, cervix, bladder, ureters, and vaginal wall. Identification of deep infiltrative lesions is critical for proper surgical planning and improved outcomes. If left undetected it can lead to higher risk surgeries involving the bowel or bladder.
A routine pelvic ultrasound is effective for detecting ovarian endometriomas, which are blood filled cysts caused by endometriosis. However, a routine pelvic ultrasound will overlook sites of deep infiltrating endometriosis. MRI has been used to identify Deep Infiltrating Endometriosis but with limited results and at 3 to 4 times the cost. A true Deep Infiltrating Endometriosis ultrasound protocol includes a detailed examination of structures that lie deep in the posterior pelvis, anterior and lateral compartments as well as the lower abdominal quadrants. Structures examined include the rectum, cecum, terminal ileum and appendix, the uterine and round ligaments, pouch of Douglas, vaginal wall, rectovaginal septum, ovarian fossa, ureters and bladder wall. An assessment of organ mobility is also performed to assess the degree of adhesions.
