Extensive diaphragmatic endometriosis Dx after liver retract
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A 30-year-old woman presented with ongoing right-sided abdominal and pelvic pain. The patient underwent surgery and a large nodule of endometriosis was removed from her right abdominal wall at the level of her umbilicus. At time of surgery few superficial lesions of endometriosis were seen on the dome of her diaphragm.

As the patient had no chest symptoms and did not consent for diaphragmatic excision of endometriosis- those lesions were not removed. The patient’s pain has not subsided and therefore a repeat laparoscopy was performed. Upon careful inspection and retraction of the liver a cluster of nodules, as well as more superficial deposits, were found on the diaphragmatic surfaces behind the liver and were excised or ablated.

Learning Points:-
• Diaphragmatic endometriosis is a rare disease and its presentation varies from no symptoms to severe cyclic thoracic pain.

• Abdominal pain is an unusual presentation. The majority of patients with the diaphragmatic disease have multiple lesions and when the diaphragmatic disease is seen at the dome, it is possible that more extensive disease is present in the deeper surfaces of the diaphragm.

• Hence, in symptomatic cases, full inspection of the diaphragm, possibly with a 30-degree telescope, and retraction of the liver to fully expose the diaphragmatic surface might be warranted to achieve full excision of diaphragmatic endometriosis lesions.

Source: https://pxmd.co/CPWws
Dr. H●●●●h D●●●i
Dr. H●●●●h D●●●i Obstetrics and Gynaecology
Endometriosis can occur at distant areas anywhere in the body due to blood born spread.
Oct 2, 2018Like