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Retrocervical, Rectovaginal Pouch, and Rectovaginal Septum Endometriosis

2001; Elsevier BV; Volume: 8; Issue: 1 Linguagem: Inglês

10.1016/s1074-3804(05)60543-9

2213-8870

Dan C. Martin, Ronald E. Batt,

Gynecological conditions and treatments

The paper by Anaf et al in this issue has a title using a global area, the rectovaginal (RV) pouch of Douglas, rather than the specific retrocervical location as the site of endometriosis. Although this is an anatomically correct title, it can suggest both rectal and vaginal involvement with endometriosis. The authors clarify that nodules were removed only from the vaginal portion of the RV pouch and not from the rectum itself. Use of the global term can create confusion similar to that noted in 1917 and 1989 articles that described RV septum involvement where this was not present. The 1917 article has illustrations and the 1989 article a magnetic resonance image (MRI) of retrocervical RV pouch endometriosis with minimal or no involvement of the RV septum. The illustrations and MRI suggest lengthening of the RV septum due to RV pouch contraction. Lengthening of the RV septum has also been associated with pregnancy. The RV pouch covers part of the vagina and rectum, and its base is the upper limit of the RV septum. The RV pouch is not the RV septum. Retroperitoneal endometriosis and posterior vaginal fornix endometriosis are behind the RV pouch, not within it. The degree of surgical treatment by Anaf et al is similar to that described for cul-de-sac endometriosis and retrocervical endometriosis. Retrocervical may be a more descriptive term for describing RV pouch, retroperitoneal, and vaginal fornix endometriosis behind or beneath the cervix with no rectal involvement. Rectovaginal is used when both vaginal and rectal areas of the pouch are involved and may include involvement of the RV septum. These distinctions are