The patterns of topographic and anatomical relations of the uterus and rectum in vivo

Abstract

Objective. The aim is to identify patterns of lifetime topographic and anatomical relationships of the rectum and uterus based on magnetic resonance imaging data to justify transvaginal surgical access to the abdominal cavity through the posterior vaginal fornix. Material and methods. The study was performed on 58 results of MRI examinations of pelvis of women of average age 41.355.45 years on the EXCELART Vantage Atlas 1.5 TSL tomograph., Toshiba, using a standard combination of pulse sequences (in modes T1-VI, T2-VI, T-1 Fsat, T-2 Fsat, DWI, T-2 STIR, section thickness 3-5 mm) without I / V contrast in a moderately filled bladder using a standard combination of pulse sequences in typical (anteversio-anteflexio) and variant (retro, sinistro et dextrodeviatio uteri) positions of the uterus. Results. It was found that in more than half of cases, the supravaginal portion of the rectum, along with the sacral flexure, is supplemented by a flexure in the frontal plane. It causes close or distant anatomical location of the rectum to the uterus. This position of organs determines the shape of recto-uterine pouch and tactics of performing transvaginal accesses to the abdominal cavity through the posterior vaginal fornix. A narrow shape of excavation serves as a reason for refusal of interventions, a wide shape is a favorable anatomical prerequisite for the implementation. The vaginal portion of rectum is in most cases represented by a sacral flexure and only 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 recto-uterine pouch. It is crucial for performing transvaginal surgical access to the abdominal cavity through the posterior vaginal fornix.