ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1626445
Mapping Deep Endometriosis in Patients with Ovarian Endometriomas according to the #Enzian Classification: A Single-Centre Retrospective Analysis
Provisionally accepted
Vimee Bindra1
Antoine Naem2,3*Swetha P1Joelle Kahla4Archana Reddy1
Antonio Simone Laganà 5
Andrea Etrusco5
Dimitrios Andrikos6
Gaetano Riemma7
Vittorio Agrifoglio5
Alin Stefan Constantin8Rudy Leon De Wilde9
Dr. Harald Krentel6- 1Apollo Health City, Hyderbad, India
- 2University of Bremen, Bremen, Germany
- 3Hospital St Joseph Stift, Bremen, Germany
- 4Faculty of Medicine of Damascus University, Damascus, Syria
- 5University of Palermo, Palermo, Italy
- 6Bethesda Hospital Duisburg, Duisburg, Germany
- 7University of Campania, Naples, Italy
- 8University of Saarland, Saarland, Germany
- 9University of Oldenburg, Oldenburg, Germany
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AbstractObjective: Endometriosis is a multifactorial disease that affects mainly women of reproductive age. It is unclear whether each form of pelvic endometriosis is an independent entity and whether a spatial relationship between all three endometriosis forms exists. We aimed with this research to examine the distribution of deep endometriosis in patients with ovarian endometriomas. We also aimed to assess the influence of unilateral and bilateral ovarian endometriomas on the distribution of deep endometriotic nodules.Methods: This is a retrospective single-centre cohort study that included all patients with histologically-proven ovarian endometriomas. The #Enzian classification was used to classify endometriosis. The distribution of deep endometriosis in patients with endometriomas was assessed.Results: A total of 106 out of 121 patients with ovarian endometriomas had coexisting deep endometriosis (87.6%). Bilateral endometriomas were more common than unilateral ones. There was a statistically significant correlation between ipsilateral ovarian endometriomas and same-sided deep endometriosis of the pelvic compartment B according to the #Enzian classification. Patients with bilateral ovarian endometriomas had deep endometriosis of the left #Enzian B pelvic compartment and rectovaginal septum at a higher frequency than patients with unilateral endometriomas.Conclusions: Patients with unilateral or bilateral ovarian endometriomas should be carefully screened for deep endometriosis of the pelvis since both types of endometriosis coexist in the great majority of patients. The surgical treatment of ovarian endometriomas only often leads to leaving deep endometriotic lesions behind. Bilateral endometriomas are associated with higher frequencies of deep endometriosis in the left #Enzian B compartment and rectovaginal septum.
Keywords: Anatomy, Endometriosis, Endometrioma, #Enzian, Deep endometriosis, distribution, Pathogenesis. 2
Received: 10 May 2025; Accepted: 03 Jul 2025.
Copyright: © 2025 Bindra, Naem, P, Kahla, Reddy, Laganà , Etrusco, Andrikos, Riemma, Agrifoglio, Constantin, De Wilde and Krentel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Antoine Naem, University of Bremen, Bremen, Germany
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