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 Mullerian rests present in the rectovaginal septum.