Rektosigmoid endometriozis (BT taklitçisi)

Özet

Derin pelvik endometriozis, çoğunlukla rektosigmoidin serozası ve muskularis tabakasını etkileyen fibrotik plak veya nodül biçiminde olabilir. Rutin BT bu hastalık için birincil tanı testi değildir; yine de pelvik ağrı ya da başka nedenle çekilen kontrastlı BT’de ön rektal duvar kalınlaşması, uterusla çekinti ve over endometrioması birlikte fark edilebilir. Bu birliktelik endometriozisi akla getirmeli ve uygun pelvik MR/ultrason değerlendirmesini yönlendirmelidir. Bulguyu yalnızca kolon kanseri ya da basit dış bası diye yorumlamak, altta yatan çok kompartımanlı hastalığı gözden kaçırabilir.

Faz ve pencere

Portal

Rutin kontrastlı pelvik BT’de rektosigmoid duvar kalınlaşması veya stenoz görülebilir; bu bulgular özgül değildir ve BT endometriozisi kolorektal kanserden özgül olarak ayıramaz.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Ön rektal duvarın serozal yüzünden başlayan fokal veya plak benzeri kalınlaşma
• Rektosigmoid ile posterior uterus/serviks arasında sınır silinmesi ve traksiyon
• Douglas boşluğunda yapışıklık izlenimi veren organların birbirine yaklaşması veya yer değiştirmesi
• Lezyon düzeyinde rektal lümenin çekilmesi ya da daralması; BT’de mukozal katman tutulumu gösterilemeyebilir
• Overde kan ürünleri içerebilen endometrioma görünümünde kistik lezyonun eşlik etmesi
• Uterosakral bağ, vajen arka duvarı veya rektovajinal aralıkta komşu plak/nodüller

Normalde

Pelvik adezyonlarda organların birbirine traksiyonu ve aradaki ayırım planlarının kaybı görülebilir; rektosigmoid kolonun açılanması da adezyonu düşündüren dolaylı bulgulardandır. Rektum ile posterior uterus arasındaki ayırım planının kaybı ve rektosigmoid kolonun açılanması pelvik adezyonları düşündürebilir.

Ayırıcı tanı

Rektosigmoid adenokarsinom

lümene bakan asimetrik duvar kitlesi, omuzlanma ve bölgesel lenf nodları endometriozis dışı neoplaziyi düşündürür.

Pelvik inflamatuvar adezyon

tüpler/adneksler çevresinde inflamasyon veya geçirilmiş cerrahi bulguları eşlik edebilir; BT’de endometriozis özgül değildir.

Metastatik peritoneal implant

birden çok peritoneal/omental nodül, asit veya primer malignite bulguları ayırıcı tanıya girer.

Rektal gastrointestinal stromal tümör, rektosigmoid submukozal tümörlerin ayırıcı tanısında yer alabilir; verilen kaynaklar bu tümörün büyüme yönünü veya BT’deki görünümünü tanımlamaz.

Tuzaklar

• BT rektosigmoid duvar kalınlaşması veya stenozu gösterebilse de bu bulgular özgül değildir; birkaç milimetrelik yüzeyel peritoneal implantların MR’da saptanması güç olabilir.
• Dıştan rektuma yapışık fibrotik plak, primer mukozal kolon tümörü sanılabilir; lezyonun anterior seroza ve posterior pelvik organlarla ilişkisini izle.
• Adneksiyal kist her zaman endometrioma değildir; BT’de içeriğin niteliği kesinleşmediğinde bunu karakterize edilmemiş kist olarak tarif et.
• BT’de normal görünen pelvik yağ planı, cerrahi/klinik olarak doğrulanmış endometriozisi dışlamaz; tanısal güven düzeyini görüntüleme yönteminin kısıtına göre sınırla.

Kendini dene

1. Pelvik ağrılı hastada BT’de rektosigmoid duvar kalınlaşması ve overde kistik lezyon görülüyor; pelvik görüntülemede rektosigmoid ile posterior uterus arasında yapışıklık ve çekinti de izleniyor. En olası açıklama?

   • Derin endometriozis
   • Rektal adenokarsinom
   • Divertikülit
   • Pelvik lenfoma
   Cevabı göster

   Derin endometriozis. Ön rektosigmoid duvardaki plak ve posterior uterusa doğru çekinti/adezyon derin endometriozisi düşündürür. BT’de rektosigmoid duvar kalınlaşması veya stenoz görülebilir; bu bulgular derin endometriozisi kolorektal kanserden özgül olarak ayırt etmez. Rektosigmoid adenokarsinom daha çok fokal asimetrik duvar kalınlaşması veya lümene uzanan kitle oluşturur; bu vinyette tariflenen plak ve organlar arası traksiyon endometriozisi destekler, ancak neoplaziyi dışlamaz.

2. Rutin BT’de rektosigmoid endometriozis şüphesi oluştuğunda ilk ve sonraki hedefli görüntüleme yaklaşımı hangisidir?

   • Önce uzman uygulayıcıyla hedefli TVUS; gerekirse pelvis MR
   • Kontrolsüz sanal kolonoskopi
   • Sadece kontrastsız böbrek BT
   • Toraks yüksek çözünürlüklü BT
   Cevabı göster

   Önce uzman uygulayıcıyla hedefli TVUS; gerekirse pelvis MR. Endometriozis değerlendirmesinde TVUS ilk basamak görüntüleme yöntemidir; MR, belirsiz TVUS bulgularında veya ameliyat öncesi yayılımı haritalamak için ikinci basamakta kullanılabilir. Rutin BT rektosigmoid duvar kalınlaşması veya stenoz gösterebilir, ancak endometriozisi kolorektal kanserden özgül olarak ayırt ettirmez.

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.