Mediocentral Compartment: Vaginal Endometriosis and Rectovaginal Septum

Vaginal endometriosis is often associated with the posterior infiltrative involvement of the uterosacral ligaments, torus uterinum, rectovaginal septum, rectum, and parametrium. Diagnosing this disease location during a preoperative workup is crucial for several reasons: (1) Patients counseling patients on the surgical procedure and the postoperative period and (2) planning the surgery, including the risk of digestive derivation with a stoma and with concomitant rectum involvement. Vaginal endometriosis diagnosis can be challenging in imaging, and it is a location where physical examination is highly specific for assessing the presence and the extent of disease but is associated with low sensitivity. The posterior vaginal fornix is the primary site for vaginal involvement, often arising from the inferior extension of a retrocervical lesion. The vaginal involvement ultrasound (US) diagnostic is very subtle and requires a high level of expertise. On MRI, vaginal involvement is reflected by the presence of a hyposignal T2 nodule under the reflection of the peritoneum behind the uterine cervix. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18(1):157–61. https://doi.org/10.1093/humrep/deg009. Bazot M, Darai E, Hourani R, et al. Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology. 2004;232(2):379–89. https://doi.org/10.1148/radiol.2322030762. Leonardi M, Singh SS, Murji A, et al. Deep endometriosis: a diagnostic dilemma with significant surgical consequences. J Obstet Gynaecol Can. 2018;40(9):1198–203. https://doi.org/10.1016/j.jogc.2018.05.041. Kondo W, et al. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2011;118(3):292–8. PubMed. Accessed January 7, 2024. https://pubmed.ncbi.nlm.nih.gov/21083863/. Bazot M, Detchev R, Cortez A, Amouyal P, Uzan S, Daraï E. Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod. 2003;18(8):1686–92. https://doi.org/10.1093/humrep/deg314. Martin DC, Batt RE. Retrocervical, retrovaginal pouch, and rectovaginal septum endometriosis. J Am Assoc Gynecol Laparosc. 2001;8(1):12–7. https://doi.org/10.1016/s1074-3804(05)60543-9. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318–32. https://doi.org/10.1002/uog.15955. Reid S, Condous G. The issues surrounding the pre-operative TVS diagnosis of rectovaginal septum endometriosis. Australas J Ultrasound Med. 2014;17(1):2–3. https://doi.org/10.1002/j.2205-0140.2014.tb00082.x. Bazot M, Thomassin I, Hourani R, Cortez A, Darai E. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2004;24(2):180–5. https://doi.org/10.1002/uog.1108. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039. Soliman AM, Fuldeore M, Snabes MC. Factors associated with time to endometriosis diagnosis in the United States. J Womens Health (Larchmt). 2017;26(7):788–97. https://doi.org/10.1089/jwh.2016.6003. Koninckx PR, Meuleman C, Oosterlynck D, Cornillie FJ. Diagnosis of deep endometriosis by clinical examination during menstruation and plasma CA-125 concentration*†. Fertil Steril. 1996;65(2):280–7. https://doi.org/10.1016/S0015-0282(16)58086-8. Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril. 2009;92(6):1825–33. https://doi.org/10.1016/j.fertnstert.2008.09.005. Becker CM, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. PubMed. Accessed February 1, 2024. https://pubmed.ncbi.nlm.nih.gov/35350465/. Roditis A, Florin M, Rousset P, et al. Accuracy of combined physical examination, transvaginal ultrasonography, and magnetic resonance imaging to diagnose deep endometriosis. Fertil Steril. 2023;119(4):634–43. https://doi.org/10.1016/j.fertnstert.2022.12.025. Bazot M, Daraï E, Biau DJ, Ballester M, Dessolle L. Learning curve of transvaginal ultrasound for the diagnosis of endometriomas assessed by the cumulative summation test (LC-CUSUM). Fertil Steril. 2011;95(1):301–3. https://doi.org/10.1016/j.fertnstert.2010.08.033. Hudelist G, Oberwinkler KH, Singer CF, et al. Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Hum Reprod. 2009;24(5):1018–24. https://doi.org/10.1093/humrep/dep013. Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40(4):464–9. https://doi.org/10.1002/uog.11102. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79(4):1023–7. https://doi.org/10.1016/s0015-0282(02)04952-x. Thomassin-Naggara I, Lamrabet S, Crestani A, et al. Magnetic resonance imaging classification of deep pelvic endometriosis: description and impact on surgical management. Hum Reprod. 2020;35(7):1589–600. https://doi.org/10.1093/humrep/deaa103. Rousset P, Florin M, Bharwani N, et al. Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging. 2023;104(3):95–112. https://doi.org/10.1016/j.diii.2022.09.004. Chassang M, Novellas S, Bloch-Marcotte C, et al. Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis. Eur Radiol. 2010;20(4):1003–10. https://doi.org/10.1007/s00330-009-1627-8. Bazot M, Bharwani N, Huchon C, et al. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol. 2017;27(7):2765–75. https://doi.org/10.1007/s00330-016-4673-z. Hottat N, Larrousse C, Anaf V, et al. Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment--initial results. Radiology. 2009;253(1):126–34. https://doi.org/10.1148/radiol.2531082113. Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006;26(6):1705–18. https://doi.org/10.1148/rg.266065048. Bazot M, Stivalet A, Daraï E, Coudray C, Thomassin-Naggara I, Poncelet E. Comparison of 3D and 2D FSE T2-weighted MRI in the diagnosis of deep pelvic endometriosis: preliminary results. Clin Radiol. 2013;68(1):47–54. https://doi.org/10.1016/j.crad.2012.05.014. Bazot M, Gasner A, Lafont C, Ballester M, Daraï E. Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images. Eur J Radiol. 2011;80(3):e331–9. https://doi.org/10.1016/j.ejrad.2010.12.006. Thomassin-Naggara I, Zoua CS, Bazot M, et al. Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol? Eur Radiol. 2024;34(12):7705–15. https://doi.org/10.1007/s00330-024-10842-0. Park SB, et al. Multilocular cystic lesions in the uterine cervix: broad spectrum of imaging features and pathologic correlation. AJR Am J Roentgenol. 2010;195(2):517–23. PubMed. Accessed February 25, 2024. https://pubmed.ncbi.nlm.nih.gov/20651212/. Kondo W, Bourdel N, Tamburro S, et al. Complications after surgery for deeply infiltrating pelvic endometriosis. BJOG. 2011;118(3):292–8. https://doi.org/10.1111/j.1471-0528.2010.02774.x. Kuhn RJ, Hollyock VE. Observations on the anatomy of the rectovaginal pouch and septum. Obstet Gynecol. 1982;59(4):445–7. Roman H, Braund S, Hennetier C, et al. Combined cystoscopic-abdominal vs. abdominal only route for complete excision of large deep endometriosis nodules infiltrating the supratrigonal area of the bladder: a comparative study. J Minim Invasive Gynecol. 2024;31(4):295–303. https://doi.org/10.1016/j.jmig.2024.01.007. Hini JD, Ferrier C, Owen C, et al. Interposing lateral pelvic peritoneum between the vaginal and digestive scares during a surgical colorectal resection for endometriosis, without associated hysterectomy. Gynecol Obstet Fertil Senol. 2020;48(5):457–9. https://doi.org/10.1016/j.gofs.2020.03.004. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2025 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Florin, M., Dabi, Y. (2025). Mediocentral Compartment: Vaginal Endometriosis and Rectovaginal Septum. In: Thomassin-Naggara, I. (eds) Imaging of Endometriosis: A Comparative Guide of US, MRI and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-82750-1_7 Download citation DOI: https://doi.org/10.1007/978-3-031-82750-1_7 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-82749-5 Online ISBN: 978-3-031-82750-1 eBook Packages: MedicineMedicine (R0)