Pelvic Endometriosis

Endometriosis is a chronic multifactorial disease. It is caused by the spread of endometrial glands and stroma outside the uterine cavity. The transvaginal ultrasound is considered the first-line, noninvasive diagnostic method for the accurate diagnosis of deep infiltrative endometriosis (DIE) in rectosigmoid and in the other locations. There are three main types of endometriotic lesions: peritoneal endometriosis, ovarian endometrioma (OMA), and pelvic DIE. OMAs can be completely asymptomatic, or they can cause symptoms as pelvic pain, dysmenorrhea, and dyspareunia. Endometriosis of the posterior compartment often involves the rectovaginal septum, posterior vaginal wall/fornix, anterior rectum/rectosigmoid bowel, and pararectal space. A consensus statement on the systematic approach to sonographic evaluation of the pelvis in women with a clinical suspicion of endometriosis was published in 2016 by the International Deep Endometriosis Analysis group with the contribution of clinicians, gynecological sonologists, advanced laparoscopic surgeons, and radiologists.