The role of MRI in evaluation of recto-sigmoid junction wall endometriosis. A case report

Abstract

Endometriosis is a condition that occurs due to the presence of endometrial glandular tissue outside the uterine cavity, more frequently at pelvic level affecting ovaries, uterosacral ligament, recto-vaginal septum, sigma or urinary bladder. The diagnosis of endometriosis involves a detailed anamnesis, gynecological examination, imagistic examinations, biochemical investigations, laparoscopy, and histological confirmation. We present herein the case of a 30-year-old patient with severe dysmenorrhea and infertility, diagnosed with profound endometriosis. The patient undergone a magnetic resonance imaging (MRI) pelvic examination with a specific protocol which includes endovaginal and endorectal instillation of gel and involves a scan of the pelvis in three planes (axial, coronal and sagittal) T2-weighted; T2 sequences with inclinations at the level of the uterus, urinary bladder and uterosacral ligaments; T1, T1 Fat Sat sequence unenhanced and post-contrast and T2 sequences post vaginal and rectal instillation of sterile gel. The MRI examination with endovaginal and endorectal instillation of sterile gel has a high specificity and sensitivity in establishing the diagnosis, allowing an accurate evaluation of the various modifications caused by endometriosis and its extent in the wall of pelvic organs. Such an investigation allows an exact preoperative mapping of lesions.