The "neurologic hypothesis'': a new concept in the pathogenesis of the endometriosis?

To cartograph the retroperitoneal infiltration of deep-infiltrating endometriosis of the rectovaginal space, we report on 467 patients who underwent laparoscopic/vaginal surgery for deep-infiltrating adenomyosis of the rectovaginal space. Exact localisation of the locoregional extension and of secondary infiltrating localisation where noted. The cervix and the rectovaginal ligament were mostly involved, while isolated lesions of the rectovaginal space were very rare. Comparisons of the most involved sites show an absolute correlation with the anatomical repartition of the pelvic sympathetic nervous system. We postulate a new "neurologic theory'' which could be one more explanation for the development of adenomyosis of the rectovaginal space and maybe the peritoneum.