A 34-year-old with deep infiltrating endometriosis involving the rectovaginal septum undergoes laparoscopy. A 4 cm nodule is found at the rectovaginal septum with involvement of the anterior rectal wall serosa. The revised ASRM (rASRM) endometriosis stage would be at least:

• A Stage IV (severe) ✓
• B Stage II (mild)
• C Stage III (moderate)
• D Stage I (minimal)

Explanation

The rASRM staging system for endometriosis assigns points based on location, size, and depth. Posterior cul-de-sac obliteration (which typically accompanies rectovaginal endometriosis) alone scores 40 points, immediately placing the patient in Stage IV (severe, total score >40). Deep infiltrating endometriosis (DIE) involving the rectovaginal septum almost invariably co-exists with significant obliteration of the Pouch of Douglas, dense adhesions, and bilateral involvement, far exceeding the Stage IV threshold. Stages I–III correspond to scores of 1–5, 6–15, and 16–40 respectively.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.