Postcoital bleeding in a case of recto-vaginal endometriosis

Haitham Torky, Ashraf Abo-Louz
In: Journal of Pregnancy and Neonatal Medicine · 2017 · vol. 01(01) · doi:10.35841/pregnancy-neonatal.1000105 · W4233986740
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes a 40-year-old woman with postcoital bleeding diagnosed with rectovaginal endometriosis requiring surgical intervention due to recurrence after hormonal therapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This paper reports a 40-year-old woman with postcoital bleeding and chronic pelvic symptoms who was found on speculum and combined vaginal/rectal examination to have a friable polypoidal mass in the posterior vaginal fornix, later diagnosed histologically as vaginal endometriosis with endometrial hyperplasia. Initial oral progesterone (dienogest) was associated with symptom recurrence and development of a new polyp plus rectovaginal involvement; ultrasound and MRI suggested a heterogeneous rectovaginal lesion with elevated CA-125, leading to exploratory laparotomy with total abdominal hysterectomy, excision of the upper vaginal portion, and partial recto-sigmoid resection of invaded musculosa (rectal mucosa spared), followed by adjuvant leuprolide. The postoperative course was uneventful aside from a localized rectovaginal hematoma that resolved conservatively. As a single case report, it is limited by lack of generalizability. This paper is centrally about endometriosis — it describes postcoital bleeding due to recto-vaginal endometriosis and its surgical management.

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Abstract

Introduction: Rectovaginal Endometriosis (RVE) is a severe form of endometriosis, less frequent than peritoneal or ovarian endometriosis. Recto-vaginal endometriosis has multiple diagnostic and management options with long-term outcomes varying according to the management strategy used. Case: A 40 years old woman complained of postcoital bleeding. Detailed history revealed that she suffered from persistent dysmenorrhea, dyschasia and constipation. Vaginal speculum examination revealed a large fleshy polypoidal mass in the posterior vaginal fornix, which was excised and biopsied. Histo-pathological examination revealed vaginal endometriosis. Four months later the mass recurred, in spite of, receiving hormonal treatment. Ultrasound and MRI revealed multiple uterine fibroids, with heterogenous lesion located in the rectovaginal area, and CA-125 was 80 u/ml. exploratory laparotomy was done after proper bowel preparation. Total abdominal hysterectomy with excision of the upper vaginal portion and a part of the anterior aspect of the recto-sigmoid was resected due to the invasion of its musculosa, short of the mucosa, with primary repair. Histo-pathological examination showed advanced endometriosis including the vaginal fornix and the rectal wall. The patient received two doses of Leuprolide Acetate 11.25 mg as an adjuvant treatment. Conclusion: All women with postcoital bleeding or pelvic pain should have a detailed history taken from them and thorough examination including speculum examination and visualization of posterior vaginal fornix to detect vaginal endometriosis. The primary line of management for recto-vaginal endometriosis is surgery, as hormonal therapy is less effective in such cases, which might be explained by difference in origin from the peritoneal disease.

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Condition tags

endometriosisbowel_endometriosisdysmenorrhea

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