OC020: Sonovaginography: Defining the normal rectovaginal septum

To establish normative data for the thickness of recto-vaginal septum (RVS) at sonovaginography (SVG). All women with a suspect of endometriosis on the basis of history, clinical examination or ultrasound who underwent laparoscopy were offered to participate in the study. All women underwent SVG during general anesthesia just prior to their laparoscopy. RVS nodules were visualized as hypoechoic lesions of various shapes. The sonographer predicted whether or not a nodule was present in the retrocervical area or in the RVS. Then the thickness of the posterior vaginal wall + /− RVS was taken at three points in the mid-sagittal plane: at the posterior fornix (retrocervical area), at the middle third of the vagina (upper RVS) and just above the perineal body (lower RVS). Surgical confirmation of recto-vaginal endometriosis was made if any of the following criteria was satisfied: histological confirmation of endometriosis in at least one resected subperitoneal nodule; visualization and palpation of a subperitoneal nodule without biopsy and another histologically proved location of endometriosis; visualization of complete obliteration of cul-de-sac and another histologically proved location of endometriosis. 23 women to date enrolled in the study. Mean age is 38 years (33–44). RVS endometriosis was confirmed in 4/23 women. Visualization of a hypoechoic nodule at SVG demonstrated sensitivity and specificity of 75% and 95% respectively. Mean thickness of vaginal wall + /− RVS at the three points in the presence/absence of a nodule is reported in table 1. Although numbers are too small, there was no correlation between thickness of vaginal wall + /− RVS and presence of disease. The visualization of hypoechoic nodules at SVG seems to be the best predictor for RVS endometriosis.