A surgical series on endometriosis-related diaphragmatic hernia

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This study reviewed 20 women operated for endometriosis-related diaphragmatic hernia, finding it often diagnosed with pneumothorax and repaired via suture or prosthesis with a low recurrence rate.

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This single-center retrospective review used a prospectively collected database to identify all patients operated for thoracic endometriosis over 20 years in whom an abdominal organ had migrated into the thoracic cavity through a diaphragmatic hernia. Twenty women (median age 36) underwent surgery for endometriosis-related diaphragmatic hernia, most commonly diagnosed alongside endometriosis-related pneumothorax (13 cases) or during exploration for catamenial thoracic pain (7 cases), with the right side affected in 18 cases. Hernia repair was performed mainly with direct suture (17 cases) or with a heterologous prosthesis (3 cases), and two patients experienced recurrent pneumothorax during follow-up. Relevance to endometriosis: This paper is centrally about endometriosis—specifically endometriosis-related diaphragmatic hernia within thoracic endometriosis syndrome.

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Abstract

BACKGROUND: Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis. METHODS: We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed. RESULTS: Twenty women of median age 36 (range 25-58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8 cm (2.5-20 cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax. CONCLUSIONS: Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax.
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Abstract

Background Thoracic endometriosis syndrome gives rise to various clinical and radiological manifestations. We reviewed the records of patients operated for intrathoracic migration of abdominal viscera through a diaphragmatic hernia secondary to thoracic endometriosis.

Methods

We retrospectively reviewed the single-center prospective collected database of all patients operated for thoracic endometriosis during the twenty years. All cases in which an abdominal organ was found to be herniated into the thoracic cavity were retrieved. Clinical and pathological data are presented and analyzed.

Results

Twenty women of median age 36 (range 25–58) years were operated for endometriosis-related diaphragmatic hernia. The hernia was diagnosed concomitantly with endometriosis-related pneumothorax in 13 cases and during the exploration of catamenial thoracic pain in seven cases. There were 18 cases on the right side and two cases on the left side. The median diameter of the hernia was 8 cm (2.5–20 cm). In seventeen cases, the hernia was repaired by direct suture, and in three cases a heterologous prosthesis was positioned. At follow-up, two patients had an episode of recurrent pneumothorax.

Conclusions

Diaphragmatic hernia should be ruled out in the presence of endometriosis-related pneumothorax or catamenial thoracic pain. Surgery is indicated to make a pathological diagnosis, restore anatomy, and prevent recurrence in patients presenting with pneumothorax. Similar content being viewed by others Data availability Data are available on demand to the corresponding author.

References

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Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Bobbio, A., Gherzi, L., Tormen, F. et al. A surgical series on endometriosis-related diaphragmatic hernia. Gen Thorac Cardiovasc Surg 72, 668–673 (2024). https://doi.org/10.1007/s11748-024-02016-y Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11748-024-02016-y

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Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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