A case of a large rectovaginal mass presenting as posterior vaginal wall prolapse

Abstract

A 66-year-old female presented with symptoms suggestive of pelvic organ prolapse, history of fibroid uterus, and rectal pressure. Pelvic examination revealed a large pelvic mass filling the posterior cul-de-sac, occupying the rectovaginal septum, and compressing the rectum. There was a stage II pelvic organ prolapse of the posterior vaginal wall with distal vaginal wall extending to the hymen during valsalva. A CT scan confirmed the large pelvic mass distinct from the uterus measuring 9.4 × 9.8 × 6.2 cm. Colorectal workup revealed adenocarcinoma of colon on screening colonoscopy with biopsies. Patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, colon resection, and abdominal resection of the pelvic mass in the rectovaginal septum and inferior to the uterus. The patient did not require any concomitant pelvic reconstruction and the posterior vaginal wall prolapse resolved after resecting the pelvic mass.

Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation

“…MRI is the modality of choice for evaluating deep infiltrating endometriosis in the rectovaginal space because it allows a more thorough assessment of the neighboring structures, compared with transvaginal US (55). Moreover, in cases of a soft-tissue mass in the rectovaginal space, MRI allows an accurate evaluation of the components of the mass and yields information on tumor extension and involvement of adjacent structures (56,57).…”