title: The rectovaginal septum: visible on magnetic resonance images of women with Mayer-Rokitansky-Küster-Hauser syndrome (Müllerian agenesis).
abstract: OBJECTIVE
  Ongoing debate exists about whether the rectovaginal septum (Denonvilliers' fascia) is myth or reality. This study evaluates magnetic resonance images (MRI) of women with Müllerian agenesis for the presence of fascial layers between the rectum and the bladder to test the hypothesis that this layer exists in the absence of the vagina.
  
  
  METHODS
  This is a secondary analysis of a study describing MRI aspects in women with vaginal agenesis before and after laparoscopic Vecchietti procedure. Study participants (n =16) had a multiplanar pelvic MR scan. Images were evaluated independently by two investigators (MH, JOLD) for the appearance of layers separate from the bladder and rectum in the area of interest, with characteristic anatomical features of the septum.
  
  
  RESULTS
  Participants' mean age was 19.4±2.6 years ± standard deviation (SD). In 12 of 16 patients (75 %) a distinct layer between rectum and bladder was identified in either the axial(4/16; 25 %) or sagittal (12/16; 75 %) scan or both. Characteristic anatomical features included lateral attachment to the levator ani muscle, cranial fusion to the cul-de-sac peritoneum,and caudal insertion into the perineal body.Conclusions Three quarters of women with Müllerian agenesis have a visible layer between bladder and rectum. As none of the participants had a vagina, these results support the existence of a rectovaginal septum, separate from a vaginal adventitia.
authors.forename: Markus
authors.initials: M
authors.lastname: Huebner
authors.forename: Katharina
authors.initials: K
authors.lastname: Rall
authors.forename: Sara Yvonne
authors.initials: SY
authors.lastname: Brucker
authors.forename: Christl
authors.initials: C
authors.lastname: Reisenauer
authors.forename: Katja Claudia
authors.initials: KC
authors.lastname: Siegmann-Luz
authors.forename: John O L
authors.initials: JO
authors.lastname: DeLancey
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000473:pathology*; D000293:Adolescent; D000013:Congenital Abnormalities / Q000473:pathology*; D005205:Fascia / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009095:Mullerian Ducts / Q000002:abnormalities* / Q000473:pathology; D012007:Rectum / Q000473:pathology*; D001743:Urinary Bladder / Q000473:pathology*; D014621:Vagina / Q000002:abnormalities* / Q000473:pathology*; D055815:Young Adult
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