Diagnosis of endometriosis 3rd part – Ultrasound diagnosis of deep endometriosis

Authors: T. Indrielle-Kelly 1,2;  F. Frühauf 1;  A. Burgetová 1;  M. Fanta 1;  D. Fischerová 1
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom, Clinical Director Mr. J. Hollingworth 2
Published in: Čes. Gynek.2019, 84, č. 4 s. 269-275


Objective: To summarise the current knowledge and trends in the diagnosis of deep endometriosis.

Design: Review article.

Setting: Centre for diagnostics and treatment of endometriosis and Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom.

Methods: Literature review.

Results: Deep endometriosis (DE) in the pelvis is divided into lesions in the anterior and posterior compartment. In the anterior compartment DE infiltrates bladder and ureters, while in the posterior compartment it is mostly uterosacral ligaments, rectum, rectosigmoid and sigmoid colon and rarely rectovaginal septum and posterior fornix. Extrapelvic endometriosis is a rare disease typically located in the proximal bowel segments (jejunum/ileum/appendix), abdominal wall including umbilicus, scars after spontaneus delivery and/or after cesarian section, lungs and diaphragm.

Conclusion: Ultrasound diagnosis of pelvic DE has a high accuracy in the hands of an experienced sonographer. Extrapelvic endometriosis is sporadic and imaging of choice depends on the location, such as use of magnetic resonance in retroperitoneal disease (sciatic nerve), computed tomography or endoscopy in thoracic lesions.


Endometriosis – ultrasound – adenomyosis – endometrioma – deep endometriosis


1. Abrao, MS., Podgaec, S., Dias, JA., et al. Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol., 2008, 15(3), p. 280–285.

2. Cornille, FJ., Oosterlynck, D., Lauweryns, JM., Koninckx, PR. Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril, 1990, 53, p. 978–983.

3. Chapron, C., Chopin, N., Borghese B., et al. Deeply infiltrating endometriosis: pathogenetic implications of the anatomical distribution. Hum Reprod, 2006, 21(7), p. 1839–1845.

4. Exacoustos, C., Malzoni, M., Di Giovanni, A., et al. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril, 2014, 102(1), p. 143–150.

5. Frühauf, F., Fanta, M., Burgetová, A., Fischerová, D. Endometrióza v těhotenství – diagnostika a management. Čes Gynek, 2019, 84(1), s. 61–67.

6. Guerriero, S., Ajossa, S., Minguez, JA., et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2015, 46, p. 534–545.

7. Guerriero, S., Condous, G., Van Den Bosch, T., et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol, 2016, 48, p. 318–332.

8. Guerriero, S., Saba, L., Pascual, MA., et al. Transvaginal ultrasound (TVS) versus Magnetic resonance (MR) for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol, 2018, 51(5), p. 563–706.

9. Hensen, JH., Van Breda Vriesman, AC., Puylaert, JB. Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography. Amer J Roentgenol, 2006, 186(3), p. 616–620.

10. Irving, JA., Clement, PB. In Diseases of the peritoneum. In Blaustein‘s patholology of female genital tract. Eds. Kurman, RJ., Ellenson, LH., Ronnett, BM. 6th Ed. Springer, 2011, p. 625–679.

11. Mettler, L., Alkatout, I., Keckstein, J., Meinhold-Heerlein, I. Endometriosis, a concise practical guide to current diagnosis and treatment. Endo Press, Tuttlingen, Germany, 2017.

12. Medeiros, LR., Rosa, MI., Silva, BR., et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet, 2015, 291(3), p. 611–621.

13. Saccardi, C., Cosmi, E., Borghero, A., et al. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol, 2012, 40(4), p. 64–69.

14. Savelli, L., Manuzzi, L., Pollastri, P., et al. Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis. Ultrasound Obstet Gynecol, 2009, 34, p. 595–600.

15. Seracchioli, R., Mabrouk, M., Montanari, G., et al. Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up. Fertil Steril, 2010, 94(3), p. 856 – 861.

16. Singh, KK., Lessells, AM., Adam, DJ., et al. Presentation of endometriosis of general surgeons: a 10-year experience. Brit J Surg, 1995, 82(10), p. 1349–1351.

17. Soriano, D., Schonman, R., Nadu, A., et al. Multidisciplinary team approach to management of severe endometriosis affecting the ureter: long-term outcome data and treatment algorithm. J Minim Invasive Gynec, 2011, 18, p. 483–488.

18. Standring, S, Gray, H. Gray‘s anatomy: the anatomical basis of clinical practice. 2008. Churchill Livingstone/Elsevier, Edinburgh, UK.

19. Williams, TJ., Pratt, JH. Endometriosis in 1000 consecutive celiotomies: incidence and management. Amer J Obstet Gynecol, 1977, 129, p. 245–250.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account