Endometriosis of the recto-vaginal septum treated by anterior resection

Two young nulliparous females with severe symptomatic recto-vaginal endometriosis that had not responded to medical treatment were considered for surgery. Pre-operatively they were investigated by laparoscopy and Magnetic Resonance Imaging (M.R.I.) which demonstrated that the lesions were confined to the recto-vaginal septum with no intraperitoneal involvement. Both patients underwent resection of the middle third of the rectum and part of the posterior wall of the vagina with preservation of the ovaries, uterus and fallopian tubes. In one patient a J-colonic pouch with colo-anal anastomosis was fashioned and in the other patient a stapled colo-rectal anastomosis. Both patients are now asymptomatic with normal bowel function six months post-operatively. Radical surgery is indicated very rarely. We believe it should be considered in young nulliparous women who wish to conceive, in whom the diagnosis has been confirmed histologically and who have severe symptoms. M.R.I. is a useful pre-operative investigation to delineate the extent of the disease.