Rectovaginal endometriosis – a frequently missed diagnosis

Abstract

To assess the proportion of women found to have rectovaginal endometriosis who underwent a previous laparoscopy with negative findings, a 5-year retrospective observational study was carried out at the University Hospital of Wales, Cardiff UK, from 2001 to 2005. A total of 61 cases with potential symptoms of rectovaginal endometriosis who underwent laparoscopy were identified. Rectovaginal endometriosis was identified in 16 of these cases. Previous laparoscopy was carried out in 33 of these 61 cases. In the group of women found to have rectovaginal endometriosis, 14 cases of rectovaginal endometriosis were not identified by pre-referral laparoscopy. This study supports the anecdotal idea that rectovaginal endometriosis is an often missed diagnosis at the time of laparoscopy. Diagnostic laparoscopy by generalist gynaecologists frequently fails to diagnose rectovaginal endometriosis. The routine use of rectal probes at laparoscopy is recommended to increase diagnostic accuracy.

Histopathology‐based combined surgical approach to rectovaginal endometriosis

“…As well as standard imaging techniques such as rectal endoscopoic ultrasound, transvaginal ultrasound, and MRI, procedural variations have been developed [1][2][3]13,[20][21][22][23][24][25]. Transvaginal ultrasound has been combined with water-contrast in the rectum to increase its accuracy, or modified to sonovaginography.…”

“…Women with rectovaginal endometriosis often suffer from dysmenorrhea, chronic pelvic pain, and intestinal symptoms such as obstipation or dyschezia [1][2][3][4]. The triad of dyspareunia, bowel symptoms, and dysmenorrhea has been identified to have a high sensitivity (greater than 80%) for rectovaginal endometriosis [5].…”

“…Bowel involvement can be diagnosed using vaginal ultrasound, pelvic (dynamic) magnetic resonance imaging (MRI), or rectal endoscopic ultrasound. The accuracies of imaging procedures and clinical examinations vary widely [1][2][3]13,[20][21][22][23][24][25].…”

Gynaecological laparoscopy: ‘see and treat’ should be the gold standard

“…Griffiths et al [11] reported that 14 of 33 cases of rectovaginal endometriosis had not been identified at primary laparoscopy by a generalist gynaecologist before laparoscopy at a tertiary referral centre. Hence, the intraoperative a use of rectal probes is strongly recommended to diagnose rectovaginal lesions [12].…”

Endometriosis of the Posterior Cul-De-Sac: Clinical Presentation and Findings at Transvaginal Ultrasound

“…whom endometriosis is confined solely to the posterior cul-de-sac, the diagnosis can be extremely difficult [1,3].…”