UTILITY OF ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING FOR PRE-OPERATIVE PLANNING IN BOWEL ENDOMETRIOSIS
Rebecca Shuford*, Michaela W. Gaffley, Judy Ugwuegbu, Scott C. Pelland, Jean Ashburn
General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC
Purpose/Background
From time to time, patients suffering from pelvic endometriosis require bowel resection to remove symptomatic endometrial implants. Ultrasonography (US) and magnetic resonance imaging (MRI) are commonly used to determine the extent of bowel involvement and whether a multidisciplinary approach with multiple pelvic surgical specialists may be needed for optimal outcomes. We sought to study a group of patients undergoing surgery for endometriosis and assess the perceived predictability of US and MRI in pre-operatively determining whether bowel resection is likely.
Methods
We performed a single-institution retrospective chart review of patients undergoing surgery for endometriosis who had pre-operative US and/or MRI, followed by operation with gynecologist and colorectal surgeon as co-surgeons.
Results
Between 01/2018-11/2021, 14 patients with endometriosis with suspected bowel involvement underwent evaluation followed by surgery. Average age was 34.6 and average BMI 35.1. Of the 9 (64.3%) patients who underwent pre-operative MRI, 8 (88.9%) had MRI findings suggestive of bowel endometriosis, and 7 (77.8%) underwent subsequent bowel resection. Of the 12 (85.7%) patients who underwent US, 2 (16.7%) had studies suggesting bowel endometriosis pre-operatively, and 10 (83.3%) underwent subsequent bowel resection (p=0.01). If either pre-operative MRI or US suggested bowel endometriosis (n=9), bowel resection was performed in 8 (88.9%) cases compared to 2 (40%) cases if neither modality suggested this diagnosis (p=0.06).
Conclusions
Preoperative imaging with US and MRI can be helpful in predicting whether bowel resection may be necessary in patients with extensive pelvic endometriosis. Further investigation into the ideal imaging protocol is necessary to better determine when a multidisciplinary surgical team is required for optimal outcomes.
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