PVF DE with bowel tethering

Viewers should focus their eyes on the area closest to the probe, the vagina. There is an area of focal thickening within the vagina, representing deep endometriosis of the posterior vaginal fornix. With the application of pressure, the operator is attempting to understand whether the bowel is tethered, which it is (demonstrated by the acute angle of the rectal wall muscularis being pulled toward the area of the deep endometriosis nodule). The hyperechoic peritoneum that is overlying the vaginal deep endometriosis is irregular and thickened.