Silvia Bernardo MD, Presenter: Nothing to Disclose

Lucia Manganaro MD, Abstract Co-Author: Nothing to Disclose

Valeria Vinci MD, Abstract Co-Author: Nothing to Disclose

Paolo Sollazzo, Abstract Co-Author: Nothing to Disclose

Matteo Saldari, Abstract Co-Author: Nothing to Disclose

Maria Eleonora Sergi MD, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

Puropose of this study has been to evaluate, with functional MRI , the pelvic floor disfunction in Patients suffering from deep infiltrating symptomatic endometriosis.

In 1 year time we performed 170 MRI for the evaluation of endometriosis.We enrolled in this study 16 patients who meet the following inclusion criteria: presence of deep infiltrating endometriosis on MRI ,symptoms of constipation or incomplete evacuation regardless menstrual cycle. Patients were asked to undergo rectal cleasing. Functional MRI examination was performed using a 1.5T magnet (Siemens Magnetom Avanto, Erlangen Germany) after endorectal administration of 300 mL gel solution using T2w HASTE sequences in static condition and T2w dynamic TRUFI sequences during rest, squeezing and active straining until complete defecation.  

In our experience, 3/16 cases were reported as negative. In 7/13 cases we diagnosed a descending perineal syndrome, with the involvement of the three compartments as well as an associated anterior rectocele in 3 cases. 3/13 Patients showed severe hypomobility of the pelvic floor with obstructed defecation characterized by unmodified ano-rectal angle . In 1/13 case, functional MRI showed the mucosa invagination which impaired defecation. 2/13 cases showed isolated anterior rectocele , which was severe in one case causing an anterior funneling of the urethra.  

This study showed an high percentage of descending perineal syndrome, which may be explained by the chronic straining effort at defecation. Moreover, the prevalence of disorders shown in this study, may suggest to complete the MRI investigation with pelvic floor evaluation in patients suffering from DIE with symptoms of bowel constipation Moreover, it has been demonstrated that functional disorders of the pelvic floor are a common clinical problem in Patients suffering from deep infiltrating endometriosis. MRI defecography allows a complete analysis of the anorectal angle, the opening of the anal canal, the function of the puborectal muscle, and the descent of the pelvic floor during defecation.  

Functional MRI should be performed in women with endometriosis and symptoms of bowel constipation; this would allow a complete evaluation of the disease also considering the functional impairment.

Bernardo, S, Manganaro, L, Vinci, V, Sollazzo, P, Saldari, M, Sergi, M, Catalano, C, Functional Study with MRI Defecography in Patients Suffering from Deep Endometriosis.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044480.html