Surgery: Rectovaginal septum, endometriosis or adenomyosis: laparoscopic management in a series of 231 patients

TLDR

A series of 231 patients with deep‑infiltrating rectovaginal septum endometriosis underwent laparoscopic excision of deep fibrotic nodules. Three bowel perforations, three urinary retentions, no other peri‑operative complications, and marked pain relief were reported, while histology showed a circumscribed nodular aggregate of smooth muscle and endometrial glands, prompting the authors to propose the term rectovaginal adenomyosis.

Abstract

A series of 231 cases of deep-infiltrating endometriosis of the rectovaginal septum is presented. Laparoscopic procedures with excision of deep fibrotic endometriotic nodules were performed in all cases. In three cases, the bowel lumen was entered. No other peri-operative complications were observed. Three cases of urinary retention were reported. The nodule resection resulted in considerable pain relief. Histologically, the rectovaginal nodule was similar to an adenomyoma. Indeed it was a circumscribed nodular aggregate of smooth muscle and endometrial glands. This form of disease must be considered as a specific disease which originates from the Mullerian rests present in the rectovaginal septum and we suggest that it be called 'rectovaginal adenomyosis'.