# Impact of lesion size and localization on symptom severity in intestinal endometriosis

## TL;DR

This study shows that the size and location of intestinal endometriosis lesions affect symptom severity, helping guide diagnosis and treatment.

## Contribution

The study identifies specific correlations between lesion size/localization and symptom severity in intestinal endometriosis.

## Key findings

- Large rectal nodules (#Enzian C3) are linked to more severe dyschezia, hematochezia, and abdominal pain.
- Combined lesions (#Enzian C and FI) are associated with more severe hematochezia and dyschezia.
- Additional bowel lesions (#Enzian FI) increase the risk of bloating and hematochezia.

## Abstract

Intestinal endometriosis (IE) often presents with dyschezia, gastrointestinal (GI) dysfunction, dyspareunia, and dysmenorrhea. The impact of lesion localization and size on the severity of symptoms remains insufficiently studied, complicating preoperative diagnosis, treatment planning, and surgical excision. The aim is to assess preoperative symptoms in women with intestinal endometriosis and to evaluate the impact of lesion localization and size according to the #Enzian classification on the severity of pain and GI symptoms.

A retrospective analysis of medical records was conducted for 135 patients with laparoscopically confirmed intestinal endometriosis (IE) at the Multidisciplinary Medical Center of Odesa National Medical University. Lesion localization and size were classified intraoperatively according to the #Enzian classification in a surgically treated cohort of women. The presence and severity of pain (dysmenorrhea, dyspareunia, dyschezia) and gastrointestinal symptoms (constipation, diarrhea, abdominal pain, bloating, nausea, fecal incontinence, hematochezia) were analyzed.

Pain and/or gastrointestinal symptoms were present in 121 patients (89.6%), while 14 patients (10.4%) did not report such symptoms. Large rectal nodules (#Enzian C3) were associated with higher severity of dyschezia, hematochezia, and abdominal pain compared with smaller lesions (#Enzian C1–C2) (p < 0.001). Hematochezia was observed only in patients with #Enzian compartment C (C2, C3) involvement. Patients with additional bowel lesions (#Enzian FI) were associated with a higher risk of bloating compared with rectal lesions alone. Combined lesions (#Enzian C and FI) are also associated with more severe hematochezia compared with #Enzian C/#Enzian FI alone (p = 0.002) and dyschezia compared with #Enzian FI alone (p = 0.03). #Enzian FI lesion size did not influence these results significantly but the analysis was likely underpowered for FI size effects.

Large rectal lesions (#Enzian C3) are associated with more severe dyschezia, abdominal pain, and hematochezia. The presence of additional intestinal lesions (#Enzian FI) is associated with increased severity of hematochezia and the risk of bloating.