Trans-vaginal ultrasound for rectal visualization in inflammatory bowel disease: A pilot case-control study

Excerpt

Intestinal ultrasound (IUS) in inflammatory bowel disease (IBD) has excellent sensitivity for colonic disease, although the sensitivity remains low for the rectum [1, 2]. This limits its usefulness as a monitoring tool in ulcerative colitis (UC) (a majority have rectal involvement; 30% may have isolated proctitis) and in Crohn’s disease (CD) with rectal involvement and perianal fistula. Although trans-perineal ultrasound is shown to predict endoscopic healing in UC, it is not possible to examine the entire rectum [3]. Trans-rectal ultrasound (TRUS) is not feasible with rectal stenosis and can be traumatic. The traditional cut-offs for bowel wall thickness (> 4 mm) and vascularity in thick and vascular rectum are also questionable [3]. Trans-vaginal sonography (TVS) had been shown to be useful as a complement to trans-abdominal sonography (TAS) in the evaluation of non-gynecological pathology of the lower intestinal tract/bladder/peritoneal cavity and draining infected pelvic collections in CD [4, 5]. There is an unmet need in the IUS armamentarium to evaluate the rectum. In this pilot study, we evaluated the feasibility of TVS in adult (> 18 years), parous, females with established IBD to assess rectal disease activity and complications in whom rectal disease activity could not be ascertained with TAS and trans-perineal scan. …