الفهرس 
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Abstract
Endometriosis is a chronic gynecologic condition in which endometrial glands and stroma exist outside the uterus they are predominately found in the pelvis, but may be present anywhere in the body. This ectopic endometrium can cause scarring, as well as produce pain-mediating factors (e.g. Prostaglandins) that contribute to symptomatology.
Some women with endometriosis are asymptomatic, while others can suffer infertility, incapacitating chronic Pelvic pain, severe dysmenorrhea, and dyspareunia.
The prevalence of endometriosis in reproductive age women is approximately 11%, although the estimates are higher for those with infertility (38 %) and women with chronic pelvic pain (71 to 87 %).
Laparoscopy has become both the diagnostic and therapeutic tool for managing this disease. The primary goal is to remove all visible lesions and adhesions, thereby restoring normal pelvic anatomy. Various surgical techniques have been described, ranging from excision to ablation. In some instances, destruction of nerve pathways, thought to be carrying pain fibers from the pelvis, is also used (i.e., uterine nerve ablation and presacral neurectomy.
This prospective controlled study was conducted in the department of Obstetrics and Gynecology, Faculty of Medicine, Minia University.
Fifty –eight patients were recruited for this study.
The recruited women were subjected to detailed hi story taking involving (personal history, menstrual history, medical history, surgical history, and obstetrical history). then General examination : to detect the;
- Height , weight , BMI.
-Pulse, blood pressure, temperature.
-Chest and cardiac examination.
Follwoed by Abdominal and pelvic examination using speculum, bimanual examination to evaluate size of the uterus and presence of any cervical, or pelvic pathology.
Trans vaginal ultrasound examination to assess the sliding sign:
The examined patients were divided into two groups .
Group[ A ] ; Positive sliding sign which means that the ant rectal wall gliding smoothly over the post cervix and post vaginal wall during TVS
Which means no POD obliteration .
group [B] ; Negative sliding sign which means that ant rectal wall not gliding over the recto-cervix during TVS which prove the prescence of POD obliteration.
Then All patients were submitted to operative laparoscopy to confirm the site and degree of endometriotic disease.
The current study resulted in:
The results of TVS include positive sliding sign which means POD is not obliterated in 39 patients (78%) , negative sliding sign which means POD is obliterated in 11 patients (22%) , endometrioma was present in 9 patients (18%) and adenomyosis was present in 6 patients (12%).
The laparoscopic results include free POD in (35) patients (70%) , obliterated POD in (15) patients (30%), endometrioma was present in (9) patients (18%), bowel DIE was present in (5) patients (10%), Uterosacral ligament (USL) endometriosis in (4) patients (8%) and tubal endometriosis in patients (4%).
POD is predicted to be obliterated using TVS in (11) patients , (9) of them due to endometrioma and only two patients are due to other causes .
During the assessment of POD by laparoscopy which is the gold standard for the diagnosis of DIE, The POD is obliterated in (15) patients , (9) of them due to endometroima , (4) of them due to bowel DIE , (1) of them due to USL DIE and (1) of them due to bilateral tubal endometriosis (bilateral hydrosalpinx).
The sensitivity , specificity , PPV and NPV for the use of the sliding sign to predict POD obliteration were 73.3 % , 100 % , 100 % and 89.7 % .
Due to high diagnostic accuracy, low level of patient discomfort and low cost, TVS is currently recommended as the first-line preoperative tool for assessment of women with suspected endometriosis.
The current study further supports the use of TVS as not only the first-line preoperative investigation of choice in women with chronic pelvic pain, but also for the diagnosis of POD obliteration using the real-time dynamic sliding sign technique.