ABSTRACT
Posterior Cul-de-sac Disease It has been suggested that deep endometriotic lesions of the posterior cul-de-sac originate from metaplasia of mu¨llerian remnants located in the rectovaginal septum, thus constituting an entity different from peritoneal endometriosis (14). However, the vast majority of these fibrotic plaques are found in the retrocervical area. The rectovaginal septum is located caudally with respect to the posterior vaginal fornix and, based on normal anatomy, may not be the real site of deep nodular endometriosis. In fact, it has been demonstrated in a living anatomy study that the base of the posterior cul-de-sac extends to at least the level of the middle third of the posterior vaginal wall (15,16).
