Vaginal endosonography to diagnose enterocoele

Area of Science:

• Pelvic floor disorders
• Diagnostic imaging
• Gastroenterology

Background:

• Enterocoele diagnosis traditionally relies on evacuation proctography, often requiring technique modification to visualize small bowel.
• Prolapsed bowel in the rectovaginal space can complicate diagnosis.
• Vaginal endosonography presents a potential alternative for visualizing the rectovaginal space.

Purpose of the Study:

• To describe and validate a simple ultrasound technique using vaginal endosonography for diagnosing enterocoele.
• To compare the diagnostic accuracy of vaginal endosonography with evacuation proctography.

Main Methods:

• Seventeen women underwent vaginal endosonography with assessment during straining.
• Enterocoele was diagnosed if bowel was visualized in the rectovaginal space during bearing down.
• Findings were subsequently compared with results from evacuation proctography.

Main Results:

• Vaginal endosonography identified enterocoele in eight cases (47%) where bowel prolapsed into the rectogenital space.
• Proctography confirmed enterocoele in six of these eight cases (75% positive predictive value).
• Vaginal endosonography correctly identified absence of enterocoele in nine cases (82% specificity, 100% negative predictive value).

Conclusions:

• Vaginal endosonography demonstrates high sensitivity (100%) and specificity (82%) for enterocoele diagnosis.
• This ultrasound technique is a quick, easy, and convenient alternative to evacuation proctography.
• Vaginal endosonography is a valuable tool for the radiological diagnosis of enterocoele.