A 34-year-old woman with known endometriosis on dienogest 2 mg daily presents with persistent deep dyspareunia and cyclical rectal bleeding. Pelvic MRI shows a 2.5 cm nodule infiltrating the rectovaginal septum and anterior rectal wall. Cystoscopy is normal. According to the ENZIAN classification, this lesion is in which compartment?

• A Compartment D (bladder, ureter)
• B Compartment B (uterosacral ligament to pelvic sidewall)
• C Compartment C (rectum, sigmoid)
• D Compartment A (vagina, rectovaginal septum) ✓

Explanation

The ENZIAN classification divides deep infiltrating endometriosis into compartments: D (vagina, rectovaginal septum), B (uterosacral ligaments to pelvic sidewall), C (rectosigmoid), plus separate categories for bladder, ureter, and other organs. D rectovaginal septum nodule with anterior rectal wall involvement falls under Compartment D. Compartment C is reserved for lesions reaching the rectal lumen with significant stenosis.

Reference: ESHRE Guideline: Management of Women with Endometriosis, 2022 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.