Rectovaginal septum adenomyotic nodules: a series of 500 cases

Abstract

Objective: Laparoscopic procedure with excision of deep fibrotic endometriotic nodules of the rectovaginal septum and histological study of the lesions.

Setting: An academic teaching hospital.

Participants: A series of 500 women undergoing laparoscopy for pelvic pain or infertility.

Results: Laparoscopic (n = 497) and laparotomic (n = 3) excision of endometriotic nodules resulted in considerable pain relief. Histologically the rectovaginal nodule was similar to an adenomyoma as it was a circumscribed nodular aggregate of smooth muscle and endometrial glands and stroma. The variations in oestrogen receptor and progesterone receptor content suggested a regulatory mechanism different from that of eutopic endometrium.

Conclusion: This form of disease should be considered as an entity distinct from peritoneal and ovarian endometriosis, and originating from the Müllerian rests present in the rectovaginal septum.