{"paper_id":"a7731735-fb1e-40de-a5ca-7892bc7f3343","body_text":"Abstract\nBackground\nThis study aims to introduce 55 patients with diaphragmatic endometriosis (DEM) who managed by pelvic endometriosis resection without resection of DEM. Also, tries to identify the most appropriate theory of DEM pathogenesis by multivariant analysis.\nMethods\n55 patients who underwent diagnostic and therapeutic laparoscopic endometriosis surgery and were diagnosed with DEM during the operation were included. Only one of the patients had symptoms of DEM and another 54 were asymptomatic. The #ENZIAN classification was used to better describe pre-operative imaging and surgical findings. During the follow-up period, all patients were asked for any DEM symptoms. Also, a second-look exploratory laparoscopy was performed on four patients with severe DEM. No patient recieved post-operative hormonal therapy after pelvic endometriosis resection.\nResults\nThe mean age was 32.7 years. Dysmenorrhea was the most common symptom among patients (81%). 94.5% had co-existing endometrioma, and 98.2% had deep pelvic endometriosis. Also, 75% of patients had evidence of ovarian chocolate cyst leakage. The present study revealed that DEM laterality was significantly associated with right-sided endometrioma and rectovaginal endometriosis size, as patients with bilateral DEM were more likely to have larger right-sided endometrioma and rectovaginal endometriosis. During a mean follow-up period of 34 months, none of the asymptomatic patients developed symptoms, while one symptomatic patient reported an improvement in chest pain. Also, the second laparoscopic exploration was performed in four patients, and it revealed improvement of DEM implantations in three and progression in one.\nConclusion\nIn conclusion, DEM is a rare presentation of endometriosis that does not have a standardized diagnosis and treatment protocol. According to cases of DEM, which can be asymptomatic, subphrenic space exploration with appropriate exposure is necessary. In our opinion, the key point of the DEM treatment in asymptomatic patients is the current treatment of pelvic endometriosis. With pelvic endometriosis resection, DEM regresses spontaneously. In our study population, no patients with expectant management of the DEM mentioned related symptoms of DEM in follow-up visits. The results of this study emphasize the need for further studies on the expectant management of DEM.\nAbbreviations\n- DEM:\n-\nDiaphragmatic endometriosis\n- ICD-10:\n-\nInternational Classification of Disease-10\n- MRI:\n-\nMagnetic Resonance Imaging\n- VAS:\n-\nVisual Analogue Scale\n- SD:\n-\nStandard Deviation\nAcknowledgements\nNA.\nFunding\nAll authors declare that they did not receive any funding for this study.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthics approval and consent to participate\nWritten informed consent was obtained from each patient for their participation in this study. The Ethics Committee of Iran University of Medical Sciences approved the study protocol (Ethical Code: IR.IUMS.REC.1403.817). This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki [51].\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.\nAbout this article\nCite this article\nHaghgoo, A., Faegh, A., Maghsoudi, R. et al. Expectant management of asymptomatic diaphragmatic endometriosis: a cross-sectional retrospective study. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04750-2\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04750-2","source_license":"CC0","license_restricted":false}