The rectovaginal septum: visible on magnetic resonance images of women with Mayer-Rokitansky-Küster-Hauser syndrome (Müllerian agenesis)

Introduction and hypothesis Ongoing debate exists about whether the rectovaginal septum (Denonvilliers’ fascia) is myth or reality. This study evaluates magnetic resonance images (MRI) of women with Mullerian agenesis for the presence of fascial layers between the rectum and the bladder to test the hypothesis that this layer exists in the absence of the vagina. Methods This isa secondary analysisof astudy describing MRI aspects in women with vaginal agenesis before and after laparoscopic Vecchietti procedure. Study participants (n=16) had a multiplanar pelvic MR scan. Images were evaluated independently by two investigators (MH, JOLD) for the appearance of layers separate from the bladder and rectum in the area of interest, with characteristic anatomical features of the septum. Results Participants’meanagewas19.4±2.6years± standard deviation (SD). In 12 of 16 patients (75 %) a distinct layer between rectum and bladder was identified in either the axial (4/16; 25 %) or sagittal (12/16; 75 %) scan or both. Characteristic anatomical features included lateral attachment to the levator ani muscle, cranial fusion to the cul-de-sac peritoneum, and caudal insertion into the perineal body. Conclusions Three quarters of women with Mullerian agenesis have a visible layer between bladder and rectum. As none of the participants hadavagina,theseresults support the existence of a rectovaginal septum, separate from a vaginal adventitia.