[Clinical study about diagnosis and management on 10 women with rectovaginal endometriosis].
OBJECTIVE
To study the diagnosis and therapy of the rectovaginal endometriosis.


METHODS
Descriptive retrospective study, between 1992 and 2002, 10 women with rectovaginal endometriosis were treated at the Peking Union Medical College Hospital.


RESULTS
The average age were 40 years old. Six patients presented with rectal irritative symptom. Three of them complained about deep dyspareunia. Eight patients complained about mild to moderate dysmenorrhea. The recto-vaginal septum should be carefully palpated. None of these patients had either clinical or objective evidence of ovarian endometriosis, nor was there evidence of any obstructive lesions of the intestine or ureters. The CA(125) levels had a sensitivity of 20%. Ultrasonography failed to find the rectovaginal endometriotic nodules. Diagnosis of the rectovaginal endometriosis was based on symptoms, vaginal and rectal examination. The Revised American Fertility Society (rAFS) stages can not evaluate the grade of the endometriosis. Four patients were given leuprolide acetate depot at 3.75 mg, 1 ampule every 28 days, and treatment had a planned duration of 3 mouths. Follow-up evaluations were set 3 mouths later. The patients showed an improvement with respect to pain during the 3 mouths treatment course but had early pain recurrence after drug suspension. The endometriotic lesions showed a slight but reduction in size during therapy but had returned to original volume within 3 mouths after cessation of the gonadotropin-releasing hormone analog (GnRH-a) treatment. Finally, all patients required further treatment with a surgical solution. Six patients succeeded to remove the nodules by laparotomy. Four patients were failed to remove the total lesions by laparoscope and transvaginal section.


CONCLUSIONS
The vaginal and rectal examination should be performed if the patients complained about tectal irritative symptom or dyspareunia. The rAFS stages had no strong association with the severity of the rectovaginal endometriosis. GnRH-a should not be considered a real therapeutic alternative to surgical treatment for patients with symptom endometriosis of rectovaginal septum. Laparotomy is efficient for the treatment of the rectovaginal endometriosis.
Wang
Han-bi
HB
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Lang
Jing-he
JH
Leng
Jin-hua
JH
Liu
Zhu-feng
ZF
Sun
Da-wei
DW
Zhu
Lan
L
D000328:Adult; D003131:Combined Modality Therapy; D004414:Dyspareunia / Q000209:etiology; D004715:Endometriosis / Q000175:diagnosis / Q000628:therapy*; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D017699:Pelvic Pain / Q000209:etiology; D012002:Rectal Diseases / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014623:Vaginal Diseases / Q000175:diagnosis / Q000628:therapy*