الفهرس 
Anatomy of female pelvisOnly 14 pages are availabe for public view
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Abstract
Deeply infiltrating endometriosis is a major gynecological problem, which is generally requires surgical treatment.
Clinical assessment, Transvaginal ultrasonography (TVS) and pelvic magnetic resonance imaging (MRI) are useful in the preoperative evaluation.
Establishing the diagnosis of endometriosis on the basis of symptoms alone can be difficult because many patients are asymptomatic, and the presentation is so variable, also there is considerable overlap with other conditions and no symptom or sign is pathognomonic.
Physical examination may provide a broad range of findings. While in some cases, the gynecologic examination may be entirely unremarkable.
When compared with surgical evaluation, pelvic examination showed poor sensitivity, specificity, and predictive values. However, a complete history and detailed physical examination assist in the identification of symptoms and signs highly suggestive of endometriosis.
Serum levels of cancer antigen-125 (CA-125) have been used as a marker for endometriosis. They are elevated in the most of the patients with endometriosis. But, they are also increased with other pelvic conditions. So CA-125 is a useful marker for disease monitoring and follow-up not for diagnosis.
Laparoscopic assessment in combination with histological examination of the excised lesions remains the gold standard for diagnosis of endometriosis.
Deep endometriotic lesions may be predominantly retroperitoneal with little or no superficial peritoneal involvement. Evaluation of the size and the depth of the nodule may be difficult at laparoscopic examination; so Identification of deep endometriosis is greatly improved by a careful preoperative examination.
Transvaginal ultrasonography (TVS) is the first line procedure for the exploration of the pelvic cavity, and is the most accessible imaging method for the diagnosis of pelvic endometriosis, In view of broad availability and good tolerability of this method.
Ultrasound may identify different sites of endometriosis such as ovarian endometrioma, abnormal nodules in the vesicouterine pouch or the bladder wall. However the value of ultrasound in diagnosing posterior lesions of endometriosis, such as hypoechoic nodules of the uterosacral ligaments, rectal or vaginal wall or retrocervical lesions are more difficult. It depends on the experience of the physicians carrying out the examinations.
MR imaging demonstrates high sensitivity, specificity, and accuracy in the prediction of the locations and extension of the disease.
It is an important method in evaluation of deep endometriosis because it is a non invasive, allows evaluation in multiple planes, and its results will tend to continuously improve over time.
The complexity of endometriosis always led us to enter into a careful decisional process.