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This is obliteration of the cul de sac seen in a patient with Stage 4 endometriosis. The rectum is stuck to the back of the cervix. This indicates the presence of invasive endometriosis of the cul de sac, cervix, uterosacral ligaments, and usually the bowel wall itself. The left ovary (O) and right uterosacral ligament (RUSL) are visible in this frame. This patient would be on a bowel prep for surgery, and most bowel resections for endometriosis can be accomplished laparoscopically. Medical therapy, laser vaporization, or electrocoagulation of this type of disease would be inappropriate.
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