Presentation
? Bowel endometriosis. Previous hysterectomy. Intermittent PV bleeding. Previous ultrasound report suggested endometriosis of the vaginal vault with possibly a small bowel nodule.
Patient Data
Anterior compartment: Normal.
MIddle compartment
Uterus : Previous subtotal hysterectomy with cervix remaining. Tethering of the posterior cervix to a large infiltrating deep endometriotic deposit measuring at least 30 x 32 mm This tethers the cervix to the anterior rectum with tethering of adjacent small bowel.
Right ovary: ovarian tissue without follicular activity is seen medial to the CIA bifurcation
Left ovary: positioned high, without follicular activity or endometrioma.
Vagina: vault involved by the torus DIE.
Posterior compartment:
Rectosigmoid: at 170 mm from anal opening is a 32 x 13 mm typical mushroom-shaped DIE
bowel endometriosis which fixes the bowel to the residual cervix and a 30 mm PoD multilocular cystic mass that contains blood products.
Pelvic small bowel: right pelvic 11 mm multilocular mass fixed to small bowel with T2-shaded
but not T1 bright content, immediately superior to the endometrioma fixed to the R USL/vault/
rectosigmoid.
PoD: obliterated
Torus: hysterectomy.
USL: right USL 25 x 17 mm T2 dark nodule fixed to pelvic and bowel DIE. Left at least
superficial tethering.
RVS: normal
Upper Abdomen: no diaphragmatic endometriosis seen.
Incidental findings: None.
Case Discussion
The MRI confirms a typical mushroom-shaped rectosigmoid DIE (bowel endometriosis), under-measured on MRI due to imaging planes (42 mm on TVUS). This fixes the bowel to the cervix/vaginal vault/multilocular right ovary endometriotic mass and is a likely cause of the post coital PV bleeding and deep dyspareunia. The right ovarian tissue extends towards the common iliac artery bifurcation and there is adjacent small bowel tethering and a second 11 mm endometriotic cystic mass. No upper abdominal endometriosis is identified.
Unable to process the form. Check for errors and try again.