Non-enhanced Transvaginal Ultrasonography

Transvaginal ultrasonography (TVS) is crucial to provide a correct informed consent, select the appropriate surgical team and assess the surgical complexity. The ultrasonographic findings of rectosigmoid deep infiltrating endometriosis (DIE) are the presence of an irregular hypoechoic nodule in the anterior wall of rectosigma. A pooled sensitivity and specificity of ultrasonography (TVS) in detecting DIE in the rectosigma of 91% and 97%, respectively, is reported. The learning curve for this kind of diagnosis is not so complex and the use of some ultrasonographic “soft markers” as presence of ultrasonographic signs of uterine adenomyosis, presence of an endometrioma, adhesions of the ovary to the uterus, presence of “kissing ovaries,” and absence of sliding sign can suggest an increased risk of presence of rectosigmoid endometriosis. The magnetic resonance has similar result in term of accuracy in comparison with transvaginal ultrasonography for this location.