Diaphragmatic Endometriosis: Diagnosis and Surgical Management — A Case Report

Wolthuis, Albert; Aelvoet, C.; Bosteels, Jan; Vanrijkel, J P

doi:10.1080/00015458.2003.11679481

Cited by 11 publications

(8 citation statements)

References 9 publications

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“…41 It is typically found on the ovaries, uterine ligaments, bladder, and bowel. It is rarely found on the diaphragm.…”

Section: Benign Metastatic Lesions To the Diaphragm Endometriosismentioning

confidence: 99%

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Tumors of the Diaphragm

Kim

Hofstetter

2009

Thoracic Surgery Clinics

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“…41 It is typically found on the ovaries, uterine ligaments, bladder, and bowel. It is rarely found on the diaphragm.…”

Section: Benign Metastatic Lesions To the Diaphragm Endometriosismentioning

confidence: 99%

“…It is rarely found on the diaphragm. 41 The theory behind the implantation of endometrial contents in the pelvis and the abdomen is retrograde menstruation. Most patients present with upper abdominal pain or shoulder pain while some patients are asymptomatic.…”

Section: Benign Metastatic Lesions To the Diaphragm Endometriosismentioning

confidence: 99%

Tumors of the Diaphragm

Kim

Hofstetter

2009

Thoracic Surgery Clinics

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“…Usually, endometriosis implants are present in the pelvis and most commonly involve the ovaries (also referred as endometriomas); however, it can occur at other extrapelvic sites. [ 1 2 3 4 ] Endometriosis is postulated to be the result of retrograde menstruation leading to the tracking of the menstrual blood along the usual pathways of circulation of the peritoneal fluid, which explains the pelvic preponderance of these implants. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

“…An estrogen responsive condition, its incidence is approximately 8–15% in the females of reproductive age group. [ 1 ] Endometriosis implants are usually present in the pelvis, commonly involved sites being the ovaries, uterosacral and broad ligaments of uterus, bladder and pelvic bowel loops. Rarely, there may be involvement of extrapelvic sites such as bowel surface, umbilicus or skin.…”

Section: Introductionmentioning

confidence: 99%

Utility of diffusion weighted imaging in diagnosing subdiaphragmatic endometriosis presenting as shoulder pain

Singh

Das

et al. 2017

Indian Journal of Radiology and Imaging

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Extrapelvic endometriosis (EPE) is a rare entity which may potentially occur at any site. Symptomatic EPE is now increasingly being managed laparoscopically. Imaging is imperative in diagnosis as well as extent delineation prior to surgery. In addition to increasing the success rate of diagnostic laparoscopy, prior knowledge of EPE at certain sites may modify the standard surgical technique. We present here an unusual case of chronic pain in the right shoulder in a 26-year-old female caused by subdiaphragmatic endometriosis (SDE). It was noticed on conventional magnetic resonance imaging (MRI) sequences; however, due to the lack of the characteristic signal intensity, imaging findings were noncontributory. Diffusion-weighted imaging (DWI) facilitated its characterization and precisely mapped the extent of involvement. SDE should be suspected in young females presenting with cyclical shoulder pain. Due to nonspecific clinical features, it may remain undiagnosed. MRI is the imaging modality of choice in evaluation of EPE. Including DWI sequence in the MR protocol increases the diagnostic precision besides delineating the extent of involvement noninvasively.

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“…Extra-pelvic disease occurring in the upper abdomen including the diaphragm is rare and represents a diagnostic challenge. In these cases, robotic assisted laparoscopic surgery associated with video assisted thoracoscopy (VATS) is the best way of treatment (Wolthuis et al, 2003). We describe two cases of robotic assisted laparoscopic surgery for the treatment of diaphragmatic endometriosis that developed an incidental tension pneumothorax during the visualisation of the lesions.…”

Section: Introductionmentioning

confidence: 99%

The importance of early diagnosis and treatment of incidental tension pneumothorax during robotic assisted laparoscopy for diaphragmatic endometriosis: a report of two cases.

Ribeiro

Freire

Leite

et al. 2021

Facts Views Vis ObGyn

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We describe two cases of diaphragmatic endometriosis treated using the robotic assisted laparoscopic approach, in which an incidental tension pneumothorax occurred during the initial inspection and assessment of diaphragmatic lesions. We demonstrate the importance of early diagnosis of this complication and report successful resolution using the thoracic drainage technique. In case one, after the pneumoperitoneum was installed, during the cavity assessment and inspection, small endometriotic lesions were observed in the tendon portion of the diaphragmatic surface. We observed a sudden increase in maximum airway pressures and a reduction in tidal volume, associated with arterial hypotension and hemodynamic instability and bulging of the diaphragm, which led to the diagnosis of a tension pneumothorax. In case two, diaphragmatic endometriotic lesions were also observed after hepatic mobilisation and following visualisation of the endometriotic lesions, an abrupt decrease in the capnography values was observed, consistent with hypertensive pneumothorax. In both cases, even after deflation of the abdominal cavity, hemodynamic instability persisted. We treated both cases with thoracic drainage, which immediately normalised respiratory parameters and resulted in hemodynamic stabilisation, and the surgical procedures were continued. During laparoscopic procedures for the treatment of diaphragmatic endometriosis, the endometriotic lesions can behave as communication hole in the tendon portion of the diaphragmatic surface and the changes in ventilatory patterns and haemodynamic instability should alert the medical team to the development of an incidental tension pneumothorax. The early identification of this complication in both cases allowed rapid intervention for chest drainage and allowed the surgical procedure to continue.

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Diaphragmatic Endometriosis: Diagnosis and Surgical Management — A Case Report

Cited by 11 publications

References 9 publications

Tumors of the Diaphragm

Tumors of the Diaphragm

Utility of diffusion weighted imaging in diagnosing subdiaphragmatic endometriosis presenting as shoulder pain

The importance of early diagnosis and treatment of incidental tension pneumothorax during robotic assisted laparoscopy for diaphragmatic endometriosis: a report of two cases.

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