Magnetic resonance imaging features of vaginal endometriosis

Deeply infiltrating endometriosis (DIE) is defined by the presence of endometrial implants penetrating under the peritoneal surface or under the wall of the pelvic organs to a depth of at least 5 mm. This case report describes a case of DIE involving vaginal wall, periurethral tissue, torus uterinus and sigmoid wall. A 46-year-old female was presented with pelvic pain and deep dyspareunia which started six years ago, after a spontaneous interruption of pregnancy and uterine curettage. The pelvic magnetic resonance imaging (MRI) showed multiple DIE lesions localized in the vaginal wall mainly in the lower third of the vagina, between the anterior vaginal wall and the urethra, on the contour of the urethra and between the torus uterinus and the sigmoid wall. After MRI, laparoscopic biopsies confirmed the DIE lesions. According to the implantion theory, we assume that in our case the vaginal endometriosis was the result of implantation of endometrial glands into the vaginal tearing during the surgical procedure of curettage. In the current literature no author has so far described a diffuse involvement of the vaginal wall in the presence of uterine curettage after interruption of pregnancy. In our case, the anterior (peri-urethral tissue), middle (vaginal wall) and posterior (torus uterinus and bowel wall) compartments are involved. We can presume that the vaginal DIE is an early lesion, while the others lesions arise from vaginal walls by a contiguous extension. On MRI with endovaginal gel these lesions were more evident rather than without gel. MRI with gel allows us to give essential preoperative mapping for the surgical removal of the DIE lesions.