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Sonorectovaginography: A New Sonographic Technique for Imaging of the Posterior Compartment of the Pelvis

Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Center for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, New South Wales, Australia; and Omni Gynecological Care, Center for Women’s Ultrasound and Early Pregnancy, St Leonards, Sydney, New South Wales, Australia.

Address correspondence to Tommaso Bignardi, MD, Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, NSW 2750, Australia. E-mail: tommaso.bignardi{at}alice.it

Objective. We describe the use of a new sonographic technique for imaging of the posterior compartment of the pelvis: sonorectovaginography. Methods. Sonorectovaginography uses instillation of fluids (saline solution and ultrasound gel) in the vagina, pouch of Douglas, and rectum for the purpose of creating acoustic interfaces between the vagina, cervix, rectum, and pouch of Douglas. We performed sonorectovaginography in a woman with chronic pelvic pain during laparoscopy. Urinary catheters were introduced into the rectum and vagina. Sterile saline solution was introduced into the abdominal cavity through a laparoscopic trocar and in the rectum via a rectal catheter. The transvaginal probe was then inserted, and sterile ultrasound gel was introduced into the vagina through the vaginal catheter under sonographic guidance. Results. Sonorectovaginography has helped us create acoustic interfaces and enhanced simultaneous visualization of the vaginal walls, posterior vaginal fornix, retrocervical area, rectovaginal septum, rectal wall, and pouch of Douglas. Conclusions. Imaging of the posterior compartment of the pelvis is of paramount importance for identification of potentially difficult endometriosis cases, such as those complicated by obliteration of the pouch of Douglas or infiltration of the retrocervical area, rectovaginal septum, or vaginal or rectal wall. Sonorectovaginography may prove helpful in evaluating this compartment of the pelvis in women with suspected deep endometriosis. Its reproducibility, tolerability, and accuracy, however, need to be validated prospectively, and normative data for the rectovaginal septum also need to be established.

Key Words: endometriosis • sonography • sonovaginography

Abbreviations: DIE, deep infiltrating endometriosis • MRI, magnetic resonance imaging • RWC, rectal water contrast • TVS, transvaginal sonography

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