Presentation
Severe pain left lower pelvis and back. A prior TVUS has diagnosed pelvic endometriosis. This MRI is to preoperatively stage disease.
Patient Data
ANTERIOR COMPARTMENT: normal.
MIDDLE COMPARTMENT:
Uterus: Anteverted retroflexed 75 mm long. Posterior external adenomyosis obliterating the
pouch of Douglas. Endometrium 2 mm thin and regular. No myometrial lesion.
Ovaries: There are 2 left ovarian unilocular 5 mm T1 hyperintense cysts, consistent with
subcentimeter endometrioma. Previously noted paraovarian cysts at KEMH MRI have resolved.
Ovaries are adherent to the uterosacral ligaments, and tethered toward the midline uterus.
Fallopian tubes: No haemato or hydrosalpinges.
POSTERIOR COMPARTMENT:
Rectosigmoid colon: At 110 mm from anal opening the mid rectal mushroom-shaped DIE bowel endometriosis with symmetric external adenomyosis obliterating the pouch of Douglas. It extends 9 mm deep into the bowel and 14 mm deep into the torus/posterior uterus/cervix. Fixed.
Pouch of Douglas: Obliterated.
Torus uterinus: DIE.
Uterosacral ligaments: normal
Rectovaginal septum: normal.
UPPER ABDOMEN: No diaphragmatic endometriosis seen.
INCIDENTAL FINDINGS: Symmetric L5 and S1 nerve root fascicles with preserved perineural
fat, no visible endometriotic involvement.
Case Discussion
Endometriosis. Predominantly posterior compartment. Obliterated Pouch of Douglas with
mid rectal mushroom-shaped DIE fixed to the symmetric external adenomyosis. Ovaries
are adherent to the uterus and tethered toward the midline, with 2 left subcentimeter
endometriomata