Rectovaginal septum endometriosis (RVSE) is a deep form of en− dometriosis in which the subperitoneal space is infiltrated by en− dometrial tissue to depths of up to 5 mm [1 ± 3]. The condition nearly always occurs in women of childbearing age, and the mean prevalence is 10 % (range 5 ±17 %) [4]. Some authors have suggested that endometriosis may occur more frequently at this particular site than the data available suggest [1, 3, 5, 6], but no consensus has been reached so far on this point.The standard treatment applied nowadays is surgery with com− plete excision of all the endometriosis encountered [1, 6 ± 16]. The rectovaginal lesions that are mainly responsible for the symptoms of this disease require specific forms of treatment. Gy− necologists should be informed before surgery about the extent to which the rectal septum is infiltrated by nodules. Surgery can be mandatory, but should not be the same if there is infiltration of the rectal wall.Background and Study Aims: Rectovaginal septal endometrios− is (RVSE) can pose serious therapeutic problems when there is infiltration of the rectal septum (which occurs in approximately half of the cases). The aim of this study was to assess the value of endoscopic ultrasonography in diagnosing rectal wall involve− ment by pelvic endometriosis. Patients and Methods: A prospective study was carried out from May 1998 to March 2003 at a single hospital center. The 30 pa− tients included in the study presented with suspected RVSE and underwent systematic anorectal endoscopic ultrasonographic exploration prior to the surgical intervention. The endoscopic ul− trasonography was carried out under general anesthesia with a 7.5−MHz miniprobe equipped with a distal balloon. Results: The anorectal endoscopic ultrasonographic examina− tion (EUS) showed the presence of endometriosis in the rectovag− inal septum in 26 patients (88 %), in the uterosacral ligaments in 10 patients (33 %), and in the ovaries in two patients (6 %). At EUS, the nodules were infiltrating the rectal wall in 17 patients (56 %). The surgical exploration demonstrated endometriosis in the rec−

In this prospective series of patients with a 1-year history of medical management, only 23% of the patients with suspected SOD underwent endoscopic sphincterotomy although 54% had an abnormally long HDTT.

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