Objective: Transabdominal ultrasonography is a basic diagnostic instrument in gynecology, but requires a fully distended bladder for clear imaging. Often, transabdominal ultrasonography may not be sufficient for diagnosis due to poor bladder distention, or a thick abdominal wall. We present a case report to assess the value of rectal ultrasonography.
Methods: The patient was a virgin, therefore vaginal exam and vaginal sonography was not possible. Ultrasound evaluation was performed using a Toshiba SSA 240 A apparatus with a 3.75 MHz convex probe. Transrectal ultrasonography was performed using the Toshiba SSA-340 A 11 MHz endovaginal probe.
Results: Endocavitary approach showed a left ovarian tumor was visualized measuring 5.18x4.89cm with solid and cystic content. CA 125 measured 175mg/dl and other values were normal range. Laparoscopy and a frozen section revealed malignancy. Left salpingo-oophorectomy and partial right salpingo-oophorectomy was performed. The final pathological diagnosis reported borderline malignancy of bilateral serous cystadenoma and bilateral lymph nodes were negative for malignancy.
Conclusions: In females with limited vagina access, manual palpation of ovarian tumors is not optional, therefore rectal examination may be contemplated as an alternative. We demonstrate the potential usefulness of transrectal ultrasonography in diagnosing ovarian tumors in this study. Transrectal examination when transvaginal approach is limited, is an feasible and effective method of evaluation of the female pelvic organs.