Bowel endometriosis in clinical practice: analysis of localizations and associations with other forms and subtypes of endometriosis according to #ENZIAN (2021)

Bowel endometriosis (BE) is one of the most severe manifestations of deep infiltrating endometriosis. The current literature provides limited data regarding its prevalence, anatomical localization, and associations with other forms of endometriosis. Understanding these features is important for improving diagnosis and treatment planning.The objective: to analyze the frequency, anatomical localizations, and forms of BE, as well as its associations with other forms and subtypes of endometriosis according to the #ENZIAN (2021) classification.Materials and methods. A retrospective analysis of 420 medical records of patients who underwent laparoscopic surgery for endometriosis at the University Clinic of Odesa National Medical University in 2019–2023 was conducted. 135 patients with BE were selected for further analysis. The anatomical characteristics of lesions and their associations with other forms of endometriosis were evaluated according to the #ENZIAN (2021) classification.Results. BE was identified in 135 (32.1%) patients who underwent surgery for endometriosis. The most common localizations were the rectosigmoid junction (45.9%) and the rectum (37.8%) – compartment C #ENZIAN. Involvement of compartment FI #ENZIAN was observed in 24.4% of patients: the sigmoid colon – in 14.1%, appendix and cecum – 3.7% each, colon – 2.2%, small intestine – 0.7%. Multifocal lesions were detected in 30.4% of cases, multicentric lesions – in 8.1%. BE most frequently coexisted with peritoneal endometriosis (compartment P) – 90.4%, involvement of the uterosacral ligaments and lateral pelvic wall (compartment B) – 80.0%, and ovarian endometriosis (compartment O) – 79.2%. Isolated BE was found in 3.7% of cases. Adhesions were present in 94.8% of patients.Conclusions. BE is present in one-third of patients with laparoscopically confirmed endometriosis and most commonly involves the rectosigmoid segment and rectum (compartment C #ENZIAN). In the majority of cases, it is associated with other forms of endometriosis and accompanied by significant adhesions.