Presentation
Preoperative endometriosis mapping. Subfertility, dyschezia.
Patient Data
ANTERIOR COMPARTMENT: normal.
MIDDLE COMPARTMENT:
Uterus: Anteverted retroflexed 67 mm long with normal morphology cavity. Endometrium 6
mm thick and regular. Anterior junctional zone thickening at 13 mm consistent with internal
adenomyosis. Fundal posterior 23 mm T2 dark with central T2 bright cyst/cavity in keeping with the external adenomyosis seen at TVUS. The bowel moves freely anteriorly and at the fundus, but there is fixation to the rectum at the torus.
Ovaries: 3 subcentimeter right unilocular T1 hyperintense, T2-shaded cysts, endometriomas.
Left 60 mm unilocular dominant cystic mass T2-shaded, T1 bright with incomplete septa and a
thin wall, either an endometrioma or hematosalpinx.
POSTERIOR COMPARTMENT:
Rectosigmoid colon: The lower/mid rectum is fixed to the uterus without deep endometriosis
demonstrated.
Pouch of Douglas: Obliterated.
Torus uterinus: Fixed to the rectum.
Uterosacral ligaments: The right nodule at ultrasound is not separately visible, as expected.
Rectovaginal septum: normal.
INCIDENTAL FINDINGS: None.
Case Discussion
Endometriosis. Predominantly middle compartment with bilateral endometriomas. Rectosigmoid
colon is fixed to the torus with an obliterated pouch of Douglas without visible deep bowel
endometriosis.