Patterns of topographic and anatomical relations of the uterus and rectum in vivo

Abstract

BACKGROUND: Magnetic resonance imaging (MRI) tomography is now widely used for the clinical assessment of the state of pelvic organs. Its findings are used in clinical practice for topographic and anatomical substantiation of transvaginal surgical access to the abdominal cavity through the posterior fornix of the vagina.

AIM: To identify topographic and anatomical relationship patterns of the rectum and uterus based on MRI data to justify transvaginal surgical access to the abdominal cavity through the posterior vaginal fornix.

MATERIAL AND METHODS: The study was performed using 58 cases of MRI examinations of the pelvis of women (average age, 41.35±5.45 years) on the EXCELART Vantage Atlas 1.5 TSL tomograph (Toshiba) using a standard combination of pulse sequences (modes T1-VI, T2-VI, T-1 Fsat, T-2 Fsat, DWI, and T-2 STIR, with section thickness of 3–5 mm) without intravenous contrast in a moderately filled bladder using a standard combination of pulse sequences in typical (anteversion–anteflexion) and variant (retro, sinistro et dextrodeviatio uteri) positions of the uterus.

RESULTS: In more than half of the cases, the supravaginal portion of the rectum, along with the sacral flexure, is supplemented by a flexure in the frontal plane. It influences the close or distant anatomical relationship of the rectum to the uterus. This position of organs determines the shape of the rectouterine pouch and techniques of performing transvaginal accesses to the abdominal cavity through the posterior vaginal fornix. A narrow shape of excavation can be a reason for refusal of interventions, and a wide shape is a favorable anatomical prerequisite for implementation. In most cases, the vaginal portion of the rectum is represented by a sacral flexure, and in a small number of cases, it is supplemented by a flexure in the frontal plane.

CONCLUSIONS: The degree of anatomical proximity of the rectum to the uterus (maximum anatomical proximity or distance) determines the shape of the rectouterine pouch. The transvaginal surgical access to the abdominal cavity through the posterior vaginal fornix is crucial.

Keywords

uterus / rectum / MRI anatomy / female pelvic organs

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