Transrectal Ultrasonography for Problem Solving After Transvaginal Ultrasonography of the Female Internal Reproductive Tract

Objective . To report the value of transrectal ultrasonography of the female internal reproductive tract as a complementary problem‐solving technique after transvaginal ultrasonography in selected patients. To date, transrectal ultrasonography of the female internal reproductive tract has been advocated in lieu of transvaginal ultrasonography for women in whom transvaginal ultrasonography cannot be performed for various reasons. Methods . Ten illustrative cases are presented of women for whom transrectal ultrasonography performed after transvaginal ultrasonography provided additional clinically important information regarding the female internal reproductive tract. Results . Transrectal ultrasonography was helpful in 2 scenarios: (1) women with a retroverted uterus in whom the endometrial stripe was virtually parallel to the ultrasound beam and thus could not be properly measured on transvaginal ultrasonography, and (2) women in whom normal or pathologic adnexal findings were distant from the vagina or obscured by intervening structures during transvaginal ultrasonography but were near the rectum or not obscured during transrectal ultrasonography. In 1 case, transrectal ultrasonography yielded a diagnosis of ectopic pregnancy that was missed prospectively on transvaginal ultrasonography because pain severely limited the examiner's ability to manipulate the transvaginal ultrasound transducer. Conclusions . Transrectal ultrasonography of the female internal reproductive tract can provide clinically useful information to complement transvaginal ultrasonography in selected patients.