Diaphragm Endometriosis Explained
Endometriosis is estimated to occur in 10-15 % of the female population. Endometriosis involves the diaphragm in 1-1.5% of patients with endometriosis. Diaphragm endometriosis is a rare occurrence. Diaphragm endometriosis can be asymptomatic and an incidental finding. As endometriosis invades deeper into the diaphragm and becomes full thickness, patients can present with right upper abdominal pain, rib cage pain, shoulder pain, scapula pain, pain on inspiration, and sometimes nausea. Similar to endometriosis in other locations, then endometriosis will invade progressively deeper, and lesions can bleed into themselves, an Endometrioma.
Diaphragm Endometriosis Results and Surgical Expectations
At the New England Center for Endometriosis we have excellent results with laparoscopic excision of endometriosis of the diaphragm, even with full thickness to the pleural space. We are able to do this with 5mm incison sites, no tubes, no drains, straight outpatient. When endometriosis is excised from the diaphragm, Dr. Robbins will work with a surgeon who specializes in laparoscopic surgery on the diaphragm. These tend to be short surgeries, and no bowel prep is needed.
Whenever possible, Dr. Robbins tries to complete all laparoscopic excision precedures in one surgery. There are some clinical situations when it is necessary to do this in a staged fashion with more than one surgery. Endometriosis of the diaphragm most often presents as menstrual-associated shoulder, scapula, and/or rib cage pain, and in some patients it will present as menstrual-associated nausea.
Where Diaphragm Endometriosis Is Typically Excised
We have excised endometriosis from both the left and right rides of the diaphragm, but the right side is more common. At laparoscopy, when looking at the liver, the diaphragm visible between the liver edge and the anterior ribs is the anterior aspect of the diaphragm. Symptomatic Endometriosis involves the posterior diaphragm more often. To visualize the posterior aspect of the diaphragm, it is necessary to either push the liver down or elevate the liver to look at the diaphragm underneath/posterior to the liver. Otherwise, diaphragm involvement will go unnoticed.
Similar to endometriosis in other locations, endometriosis of the diaphragm is excised. Depending on the depth of the endometriosis lesions, some diaphragm excisions will be full thickness with entry into the pleural space. When endometriosis is excised from the diaphragm, I work with a surgeon who specializes in laparoscopic surgery on the diaphragm. Full thickness excisions of the diaphragm are repaired, usually with permanent sutures.
It is important to evaluate the entire abdomen and pelvis. Peritoneal pockets and other subtle lesions on the pelvic sidewalls can radiate pain into the upper abdomen and rib cage. Laparoscopic excision of pelvic sidewall endometriosis can sometimes relieve upper abdominal pain.
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