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Rectovaginal Septum Endometriosis

  • Gernot Hudelist
  • Kristine Aas-Eng

Abstract

The rectovaginal septum (RVS) is located in the posterior compartment of the pelvis situated retroperitoneally between the posterior wall of the vagina and the anterior part of the rectum [1]. It is a specific anatomical structure consisting of strong connective tissue between the rectum and the vagina. Histopathological studies have demonstrated that it is formed of a network of collagen and elastic fibres, small vessels, smooth muscle cells and nerve fibres predominantly deriving from the autonomic inferior hypogastric plexus [2]. It thereby connects the perineal body and endopelvic fascia (Fig. 11.1). Anatomically the RVS is described to extend from the base of the rectovaginal pouch of Douglas to the urogenital diaphragm at the top of the perineal body (Fig. 11.2) [3].

References

  1. 1.
    Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003;18(1):157–61.CrossRefGoogle Scholar
  2. 2.
    Stecco C, Macchi V, Porzionato A, Tiengo C, Parenti A, Gardi M, et al. Histotopographic study of the rectovaginal septum. Ital J Anat Embryol. 2005;110(4):247–54.PubMedGoogle Scholar
  3. 3.
    Martin DC, Batt RE. Retrocervical, retrovaginal pouch, and rectovaginal septum endometriosis. J Am Assoc Gynecol Laparosc. 2001;8(1):12–7.CrossRefGoogle Scholar
  4. 4.
    Kavallaris A, Kohler C, Kuhne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod. 2003;18(6):1323–7.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Hudelist G, Ballard K, English J, Wright J, Banerjee S, Mastoroudes H, et al. Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2011;37(4):480–7.CrossRefGoogle Scholar
  7. 7.
    Guerriero S, Ajossa S, Gerada M, Virgilio B, Angioni S, Melis GB. Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis. Hum Reprod. 2008;23(11):2452–7.CrossRefGoogle Scholar
  8. 8.
    Exacoustos C, Malzoni M, Di Giovanni A, Lazzeri L, Tosti C, Petraglia F, et al. Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril. 2014;102(1):143–50. e2CrossRefGoogle Scholar
  9. 9.
    Hudelist G, Keckstein J, Wright JT. The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis. Fertil Steril. 2009;92(5):1536–43.CrossRefGoogle Scholar
  10. 10.
    Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Darai 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.CrossRefGoogle Scholar
  11. 11.
    Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2011;37(3):257–63.CrossRefGoogle Scholar
  12. 12.
    Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47(3):281–9.CrossRefGoogle Scholar
  13. 13.
    Bazot M, Malzy P, Cortez A, Roseau G, Amouyal P, Darai E. Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2007;30(7):994–1001.CrossRefGoogle Scholar
  14. 14.
    Grasso RF, Di Giacomo V, Sedati P, Sizzi O, Florio G, Faiella E, et al. Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography. Abdom Imaging. 2010;35(6):716–25.CrossRefGoogle Scholar
  15. 15.
    Ros C, Martinez-Serrano MJ, Rius M, Abrao MS, Munros J, Martinez-Zamora MA, et al. Bowel preparation improves the accuracy of the transvaginal ultrasound in the diagnosis of Rectosigmoid deep infiltrating endometriosis: a prospective study. J Minim Invasive Gynecol. 2017;24:1145.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    Hudelist G, Oberwinkler KH, Singer CF, Tuttlies F, Rauter G, Ritter O, et al. Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Hum Reprod. 2009;24(5):1018–24.CrossRefGoogle Scholar
  18. 18.
    Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, 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.CrossRefGoogle Scholar
  19. 19.
    Kuhn RJ, Hollyock VE. Observations on the anatomy of the rectovaginal pouch and septum. Obstet Gynecol. 1982;59(4):445–7.PubMedGoogle Scholar
  20. 20.
    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.CrossRefGoogle Scholar
  21. 21.
    Bouaziz J, Soriano D. Complications of colorectal resection for endometriosis. Minerva Ginecol. 2017;69(5):477–87.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gernot Hudelist
    • 1
  • Kristine Aas-Eng
    • 1
  1. 1.Department of GynecologyHospital St. John of GodViennaAustria

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