Presentation
Preoperative endometriosis mapping. A 28 mm bowel lesion seen 10 cm from anal verge at DIE ultrasound.
Patient Data
ANTERIOR COMPARTMENT: normal.
MIDDLE COMPARTMENT:
Uterus: Anteverted anteflexed 75 mm long with normal morphology. Endometrium 4 mm thin
and regular, distorted anteriorly at the fundus by a 20 mm partially submucosal circumscribed
T2 dark mass (FIGO 2) fibroid. Mobility fixed. A few other T2 dark circumscribed myometrial
masses (fibroids) are noted. Right fundal junctional zone thickening 22 mm transverse diameter, no T2 or T1 hyperintense foci, adenomyoma.
Ovaries: Right ovary is fixed to the upper rectal endometriosis/uterus. Contains a 16 mm
unilocular cyst with T1 hyperintense content, T2 hyperintense/decreased signal fluid fluid level
either a hemorrhagic follicle or endometrioma. No left endometrioma. 20 mm dominant follicle. Left ovary position anterior/above the uterus, inaccessible.
Fallopian tubes: No haemato or hydrosalpinges.
POSTERIOR COMPARTMENT:
Rectosigmoid colon: At 130 mm from anal opening is an elongated crescentic upper rectal
bowel endometriosis at least 37 mm long, 6 mm deep, fixing the uterine torus on the right to the rectum obliterating the pouch of Douglas.
Pouch of Douglas: Obliterated.
Torus uterinus: Fixed to the rectum.
Uterosacral ligaments: Right USL thickened, fixed to the upper rectal DIE/right ovary.
Rectovaginal septum: normal.
UPPER ABDOMEN: No diaphragmatic endometriosis seen.
INCIDENTAL FINDINGS: None.
Case Discussion
Endometriosis. At 130 mm from anal opening is an elongated crescentic upper rectal bowel
endometriosis at least 37 mm long, 6 mm deep, fixing the uterine torus on the right to the
rectum obliterating the pouch of Douglas.
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