Presentation
Severe endometriosis with adherent ovaries. PR bleeding with menstruation.
Patient Data
ANTERIOR COMPARTMENT: normal.
MIDDLE COMPARTMENT:
Uterus: Anteverted retroflexed measuring 132 x 85 x 104 mm, was 119 x 86 x 96 mm. Endometrium 1 mm thin and regular. Multiple myometrial T2 dark circumscribed masses consistent with benign fibroids. Right posterior 77 mm ill-defined T2 decreased myometrial signal without T1 or T2 bright foci is consistent with diffuse adenomyosis.
Ovaries: Adherent to the posterior uterus, with follicular activity but no endometrioma.
Fallopian tubes: Left hematosalpinx partially resolved.
POSTERIOR COMPARTMENT:
Rectosigmoid colon: At the right uterine fundus there is a 20 mm segment of sigmoid colon on T2 weighted imaging looks asymmetrically thickened, similar to the 2017 MRI suggesting a crescentic bowel endometriosis, however the thickening is not confirmed on the T1-weighted images. This resolves on the subsequent lumbar spine MRI.
Pouch of Douglas: normal
Torus uterinus: Superficial fibrosis.
Uterosacral ligaments: normal.
Rectovaginal septum: normal.
UPPER ABDOMEN: No diaphragmatic endometriosis seen.
INCIDENTAL FINDINGS: None.
Case Discussion
Large fibroid and adenomyotic uterus, without convincing identifiable bowel endometriosis to explain the PR bleeding during menstruation.
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