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Dan C. Martin, MD
Daniel Clyde Martin, M.D. (901) 347-8331 Updated information is
at Click for information
on: |
AAGL 33rd Annual Meeting
This and a companion poster in PDF format are
linked in the summaries below.
Deep Infiltration of
Endometriosis is Associated with an Increased Risk of Rectovaginal Fistula Jennifer Swoboda, MD and Dan Martin, MD University of Tennessee Health Science Center, Memphis, Tennessee
Printable PDF Version The study was a chart review of 114 consecutive patients with bowel and/or vaginal endometriosis. 93 of these had surgery during the study period. 42 of the surgical patients had rectovaginal involvement. Rectovaginal endometriosis is defined, for this study, as endometriosis that obliterates part or all of the Pouch of Douglas (POD). This is also classified as Adamyan Stage IV Retrocervical Endometriosis. 42 patients with true rectovaginal involvement were identified of 93 surgically confirmed patients. 31 (74%) of these 42 had complete POD obliteration. The rectovaginal lesion was located in the upper (cephalad) fifth of the vagina in all 42 women. 10 of these had extension into the upper third and four of those into the middle third of the posterior vagina. All 42 were Adamyan Stage IV. Most rectovaginal endometriosis is located in the upper fifth of the posterior vagina or higher. This anatomic position facilitates resection at laparoscopy or laparotomy. A measurement of less than 8 cm to the nodule edge on rectal or vaginal exam was associated with higher complication rates in this small population. Rectovaginal endometriosis is a term that describe endometriosis that is also rectocervical and rectocorporeal as seen in the third illustration.
Rectovaginal Fistulas and Pelvic Abscess after Resection of Rectovaginal Endometriosis Jennifer Swoboda, MD and Dan Martin, MD University of Tennessee Health Science Center, Memphis, Tennessee
Printable PDF Version Three women with endometriosis infiltrating into the middle third and possibly into the lower half of the vagina had bowel resection and anastomosis in 1997 and 1998. Although these 3 women had been classified as having involvement of the rectovaginal septum (Adamyan Retrocervical Stage IV), this is to the level of the septum but not into the area of the septum. Bowel resection and anastomosis was complicated by rectovaginal fistula in 2 women and perirectal abscess in the third. Both of the women who preserved their uterus had rectovaginal fistulas. Rectovaginal fistulas occurred on post-operative days 14 and 15 in two women. Hospitalization for an abscess was on day 12 in the third woman. No new cases have been noted at this level since 1998. The fistulas occurred at the level of the bowel anastomosis and not at the area of the upper vaginal resection.
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