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CT Enteroclysis Finds Colorectal Endometriosis


 

CHICAGO — Multislice CT with enteroclysis is an effective method to detect colorectal involvement in patients with endometriosis, Dr. Ennio Biscaldi reported at the annual meeting of the Radiological Society of North America.

Women affected by pelvic endometriosis usually undergo surgery to detect bowel involvement. If intestinal loops are involved, a second surgery is then required to resect the involved loop.

The main advantage of CT enteroclysis over the standard of video laparoscopy is that it provides a good view of the intestinal wall and the depth of involvement of the bowel wall, allowing surgeons to determine before the intervention if an intestinal resection is needed.

“With our technique, surgeons have an instrument for preoperative planning,” Dr. Biscaldi said in an interview. “We detect the bowel involvement and evaluate the depth of loop infiltration to plan preoperatively if a nodulectomy or an intestinal resection is needed. The patient is informed in advance, and the abdominal surgeon, if needed, is called to operate with the gynecologist.”

The disadvantages of the imaging technique are that it may underestimate submucosal involvement, may not always recognize very small nodules, and uses ionizing radiation in women of reproductive age, said Dr. Biscaldi, a radiologist with San Martino Hospital, Genoa, Italy.

Dr. Biscaldi and his colleagues reported preliminary results from a study in which 30 women, aged 27–40 years, with known ovarian endometriosis and symptoms of pelvic pain, dyspareunia, and tenesmus suggesting colorectal endometriosis were evaluated with a 16-slice CT scan. The colon was distended with a water enema before the contrast medium (iopamidol at 1.5 cc/kg of body weight) was injected. Within 20 days of the exam, regardless of the scan findings, all women underwent laparoscopy.

In 28 patients, multislice CT enteroclysis detected the site of endometriosis and colorectal wall involvement. Deeper nodules had infiltrated the serosa in 9 patients, the muscularis in 16, and the submucosa in 3.

Endometriosis of the last ileal loop also was identified in one patient.

In seven patients (23%), small, 4- to 5-mm serosal nodules were detected near the colon. They had not infiltrated the intestinal loops and were easily removed, he said. Nine patients underwent nodulectomy, and 19 underwent intestinal resection.

Two patients had no bowel endometriosis.

There have been no false positives with the imaging technique, said Dr. Biscaldi, adding that larger studies are needed to validate the findings.

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