The aim of this systematic review and meta-analysis was to evaluate the diagnostic accuracy of the sliding sign on transvaginal ultrasound (TVS) in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis, using laparoscopy as the reference standard.
A search for studies evaluating the role of the sliding sign in the assessment of pouch of Douglas obliteration and/or bowel involvement using laparoscopy as the reference standard published from January 2000 to October 2021 was performed in PubMed/MEDLINE, Web of Science, CINAHL, The Cochrane Library, ClinicalTrials.gov and SCOPUS databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of the studies. Analyses were performed using MIDAS and METANDI commands in STATA.
A total of 334 citations were identified. Eight studies were included in the analysis, resulting in 938 and 963 patients available for analysis of the diagnostic accuracy of the sliding sign for pouch of Douglas obliteration and bowel involvement, respectively. The mean prevalence of pouch of Douglas obliteration was 37% and the mean prevalence of bowel involvement was 23%. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting pouch of Douglas obliteration were 88% (95% CI, 81-93%), 94% (95% CI, 91-96%), 15.3 (95% CI, 10.2-22.9), 0.12 (95% CI, 0.07-0.21) and 123 (95% CI, 62-244), respectively. The heterogeneity was moderate for sensitivity and low for specificity for detecting pouch of Douglas obliteration. The pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of the sliding sign on TVS for detecting bowel involvement were 81% (95% CI, 64-91%), 95% (95% CI, 91-97%), 16.0 (95% CI, 9.0-28.6), 0.20 (95% CI, 0.10-0.40) and 81 (95% CI, 34-191), respectively. The heterogeneity for the meta-analysis of diagnostic accuracy for bowel involvement was high.
The sliding sign on TVS has good diagnostic performance for predicting pouch of Douglas obliteration and bowel involvement in women with suspected endometriosis. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Growing teratoma syndrome is an uncommon complication of malignant germ cell cancer, characterised by the development of large tumours during or after chemotherapy, despite normalisation of tumour marker levels and metastasis, which contain only mature teratoma. Given its low incidence, little is data available. The authors present the case of a 15-year-old girl with a growing teratoma and the literature review outlines the current knowledge of its pathogenesis, common sites, diagnosis, natural course, treatment, and prognosis.

The pouch of Douglas may become occupied by a variety of mass-like lesions, which may be challenging to providers who treat women. These lesions may initially be thought to arise from the uterus or adnexa. We conducted a literature review using a Medline search of the terms \"Douglas\' pouch,\" \"pouch of Douglas,\" \"cul-de-sac,\" and \"rectouterine pouch.\" A review of the scope of pouch of Douglas lesions is presented to assist in developing a differential diagnosis if a patient with such a lesion is encountered.

We report 2 cases of growing teratoma syndrome (GTS) in patients who had been treated with surgery and chemotherapy for immature ovarian teratoma. One of the patients presented with probable paraneoplastic encephalitis. Resection of \"recurrences\" in both patients showed deposits of mature teratoma and extensive gliomatosis peritonei. It is important for both pathologists and clinicians to be aware of this uncommon entity to avoid misdiagnosis of GTS as recurrence of immature teratoma and disease progression, and to avert unnecessary continuation of chemotherapy. GTS may occur several years after diagnosis of the primary tumor, and rarely develop in treated patients who have become pregnant. Surgical debulking is the optimal modality of treatment as GTS is not chemosensitive. If surgical debulking of GTS is incomplete, long-term follow-up with imaging is required to avoid complications such as bowel obstruction and the sequelae of pressure effects (such as vascular thrombosis, fistula formation, etc.) from bulky deposits of mature teratoma/GTS and gliomatosis peritonei.

OBJECTIVE: This review aims to sum up current knowledge on the sensitivity and specificity of ultrasound features suggestive of acute pelvic inflammatory disease (PID).
METHODS: A PubMed database search was undertaken, using the MeSH terms \"(pelvic inflammatory disease or salpingitis or adnexitis) and ultrasonography\". We included original articles evaluating the performance of vaginal ultrasound in detecting acute PID.
RESULTS: Seven articles were selected, including between 18 and 77 patients each. The golden standard used was laparoscopy/endometrial biopsy in six studies and mostly clinical evaluation in one. \"Thick tubal walls\" proved to be a specific and sensitive ultrasound sign of acute PID, provided that the walls of the tubes can be evaluated, i.e., when fluid is present in the tubal lumen (100 % sensitivity). The cogwheel sign is also a specific sign of PID (95-99 % specificity), but it seems to be less sensitive (0-86 % sensitivity). Bilateral adnexal masses appearing either as small solid masses or as cystic masses with thick walls and possibly manifesting the cogwheel sign also seems to be a reasonably reliable sign (82 % sensitivity, 83 %specificity). Doppler results overlap too much between women with and without acute PID for them to be useful in the diagnosis of acute PID, even though acutely inflamed tubes are richly vascularized at color Doppler.
CONCLUSIONS: Even though the results of our review suggest that transvaginal ultrasound has limited ability to diagnose acute PID, it is likely to be helpful when managing women with symptoms of acute PID, because in some cases the typical ultrasound signs of acute PID can be detected.

OBJECTIVE: Angiomyolipoma is the most common mesenchymal tumour of the kidney. It has been reported in several other sites outside the kidney, mainly in the liver. We report the first case of atypical pleomorphic angiomyolipoma in a man, arising from the pouch of Douglas and extending to the entire abdominal cavity.
METHODS: A 17-year-old man underwent a complete resection of a giant abdominopelvic mass. The tissue was formalin fixed and paraffin embedded and 4 micro m thick histological sections were stained with haematoxylin-eosin. Immunohistochemical stains for HMB-45, smooth muscle actin, vimentin, calponin, S100 and desmin were performed. Sections for electron microscopy were also prepared.
RESULTS: Microscopic examination revealed a neoplasm composed of pleomorphic epithelioid cells with atypical features, immunoreactive for HMB-45, MART-1, actin, vimentin and calponin, while S100 protein and desmin stains were negative. Ultrastructurally, the tumour cells showed prominent nucleoli, vacuolated cytoplasm, and some premelanosomes. A diagnosis of atypical pleomorphic epithelioid angiomyolipoma was then made.
CONCLUSIONS: To date five patients with abdominal epithelioid angiomyolipoma have been described in the literature. All were women. Three of the five patients reported developed metastasis, while our patient is still free of disease at 16 months of follow-up. Clear prognostic pathological features have not been identified.

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OBJECTIVE: To determine the effectiveness and safety of the new technique of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension by suturing method, with no transvaginal surgical approach.
METHODS: The clinical prospective study included 276 women, and was conducted from July 1990 through December 1995. All women were subjected to a laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal and pouch of Douglas reconstruction and vaginal vault suspension. The entire operation was executed via laparoscope with suturing and tying of extracorporeal sliding and intracorporeal two-turn flat square knot technique, and no transvaginal surgery was performed. The criteria for postoperative early (within 5 h) discharge plan were designed and assessed.
RESULTS: All pre-planned instances of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension were completed; no technique failure was encountered. The average operating time for both hysterectomy and prophylactic surgery was 192 min. Intraoperative complications were two bladder injuries (0.72%); one case of inferior epigastric vessels injury (0.36%); one case of autologous, cells saver processed blood transfusion (0.36%). The immediate postoperative complications were four cases of voiding difficulty (1.45%) and five patients experiencing post anesthesia inordinate nausea and vomiting (1.81%). One patient required postoperative blood transfusion (0.36%). Delayed postoperative complications included 2 patients (0.72%) with superficial incisional skin infection. Estimated hemoglobin loss was from 0.5 g/dl to 5.0 g/dl, mean loss 1.5 g/dl. The extirpated uterine average weight 163 g. Postoperatively, within 24 h, 265 patients (96.01%) out of 276 were discharged home on the day of surgery, within 5 h, 110 patients (41.51%) out of 265 left the surgical unit. There was no single hospital post surgical re-admission.
CONCLUSIONS: Laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault suspension by suturing method is a safe, well-defined operation, executed with no need for transvaginal surgical approach, and well accepted by patients.

Pulsion enterocele has a well-deserved reputation as a difficult surgical problem; the multiplicity of suggested solutions attests to this. Until the functional anatomy of the pelvic floor is better understood, particularly the specific anatomic defects involved, planning of a rational surgical attack will remain elusive. Both the pelvic cellular tissues and the levator ani complex are involved in the genesis of the condition, and both require correction during any surgical procedure. The supporting effect of the levator complex and the positioning effect of the cellular tissues must be restored.

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