Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis
ObjectiveEndometriosis 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 t...
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Frontiers Media S.A.
2025-07-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1626445/full |
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| author | Vimee Bindra Antoine Naem Antoine Naem P. Swetha Joelle Kahla Archana Reddy Antonio Simone Laganà Andrea Etrusco Dimitrios Andrikos Gaetano Riemma Vittorio Agrifoglio Alin Constantin Rudy Leon De Wilde Harald Krentel |
| author_facet | Vimee Bindra Antoine Naem Antoine Naem P. Swetha Joelle Kahla Archana Reddy Antonio Simone Laganà Andrea Etrusco Dimitrios Andrikos Gaetano Riemma Vittorio Agrifoglio Alin Constantin Rudy Leon De Wilde Harald Krentel |
| author_sort | Vimee Bindra |
| collection | DOAJ |
| description | ObjectiveEndometriosis 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.MethodsThis is a retrospective single-center 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.ResultsA 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.ConclusionDeep Endometriosis coexists with unilateral or bilateral ovarian endometriomas in the great majority of patients. Bilateral endometriomas are associated with higher frequencies of deep endometriosis in the left #Enzian B compartment and rectovaginal septum (#Enzian A). In order to avoid incomplete surgeries and complications, patients with endometriomas should be carefully screened for deep endometriosis of the pelvis using transvaginal ultrasound or MR imaging. |
| format | Article |
| id | doaj-art-4beff7350fb8405aa939480a105b0ff2 |
| institution | DOAJ |
| issn | 2296-858X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj-art-4beff7350fb8405aa939480a105b0ff22025-08-20T02:48:15ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.16264451626445Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysisVimee Bindra0Antoine Naem1Antoine Naem2P. Swetha3Joelle Kahla4Archana Reddy5Antonio Simone Laganà6Andrea Etrusco7Dimitrios Andrikos8Gaetano Riemma9Vittorio Agrifoglio10Alin Constantin11Rudy Leon De Wilde12Harald Krentel13Endometriosis Centre, Apollo Health City, Hyderabad, IndiaFaculty of Mathematics and Computer Science, University of Bremen, Bremen, GermanyCentral Surgical Unit, Hospital St. Joseph Stift, Bremen, GermanyEndometriosis Centre, Apollo Health City, Hyderabad, IndiaFaculty of Medicine of Damascus University, Damascus, SyriaEndometriosis Centre, Apollo Health City, Hyderabad, IndiaUnit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, ItalyUnit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, ItalyDepartment of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, Duisburg, GermanyObstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, ItalyUnit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, ItalyDepartment of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, GermanyUniversity Hospital for Gynecology, Carl von Ossietzky University, Oldenburg, GermanyDepartment of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, Duisburg, GermanyObjectiveEndometriosis 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.MethodsThis is a retrospective single-center 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.ResultsA 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.ConclusionDeep Endometriosis coexists with unilateral or bilateral ovarian endometriomas in the great majority of patients. Bilateral endometriomas are associated with higher frequencies of deep endometriosis in the left #Enzian B compartment and rectovaginal septum (#Enzian A). In order to avoid incomplete surgeries and complications, patients with endometriomas should be carefully screened for deep endometriosis of the pelvis using transvaginal ultrasound or MR imaging.https://www.frontiersin.org/articles/10.3389/fmed.2025.1626445/fullanatomyendometriosisendometrioma#Enziandeep endometriosisdistribution |
| spellingShingle | Vimee Bindra Antoine Naem Antoine Naem P. Swetha Joelle Kahla Archana Reddy Antonio Simone Laganà Andrea Etrusco Dimitrios Andrikos Gaetano Riemma Vittorio Agrifoglio Alin Constantin Rudy Leon De Wilde Harald Krentel Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis Frontiers in Medicine anatomy endometriosis endometrioma #Enzian deep endometriosis distribution |
| title | Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis |
| title_full | Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis |
| title_fullStr | Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis |
| title_full_unstemmed | Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis |
| title_short | Mapping deep endometriosis in patients with ovarian endometriomas according to the #Enzian classification: a single-center retrospective analysis |
| title_sort | mapping deep endometriosis in patients with ovarian endometriomas according to the enzian classification a single center retrospective analysis |
| topic | anatomy endometriosis endometrioma #Enzian deep endometriosis distribution |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1626445/full |
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