Rectovaginal septum adenomyotic nodules: a series of 500 cases.

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.