At a large referral center in Sao Paulo, Brazil, TVUS with bowel preparation had better sensitivity and specificity for deep retrocervical and rectosigmoid disease compared with MRI and digital pelvic examination.
Mary undergoes TVUS with bowel preparation, which reveals a normal uterus and adnexa and the presence of 2 lesions, a 2x1.5-cm retrocervical lesion and a 1.8x2-cm rectosigmoid lesion 9 cm above the anal verge.
However, the bimanual examination can help to estimate uterine or pelvic pain, pain localization, uterine size and mobility, adnexial masses, and the presence of deep infiltrating endometriosis in the retrocervical
region like the rectovaginal septum.
In contrast to superficial disease, deep endometriosis constitutes the most severe form of endometriosis and includes nodules affecting the pouch of Douglas, retrocervical area, bladder, ureter, or the intestinal wall.
The presence of a hypoechoic lesion located in the posterior pelvic compartment (see Figure 1) is suggestive of endometriosis, with diagnostic sensitivity greater than 95% for retrocervical lesions and greater than 98% for rectal lesions (Hum.