Asymmetry in distribution of diaphragmatic endometriotic lesions: evidence in favour of the menstrual reflux theory

P Vercellini, Paolo Vercellini, A Abbiati, Annalisa Abbiati, P Viganò, Paola Viganò, Edgardo Somigliana, E D Somigliana, R Daguati, Raffaella Daguati, F Meroni, Francesca Meroni, Pier Giorgio Crosignani, P G Crosignani
Human Reproduction · 2007 · vol. 22(9) , pp. 2359–2367 · doi:10.1093/humrep/dem224 · PMID:17636274 · W2123446124
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This review of diaphragmatic endometriosis cases found a significant asymmetry favoring right-sided lesions, supporting the menstrual reflux theory.

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Abstract

BACKGROUND: If the menstrual reflux or implantation theory of endometriosis is true, refluxed endometrial cells could reach the right hypochondrium transported by the clockwise peritoneal fluid current and would implant more easily on the right diaphragmatic leaf as they are stuck there by the falciform ligament. METHODS: To investigate if a lateral asymmetry exists in diaphragmatic endometriotic lesion distribution, all articles on diaphragmatic endometriosis identified by MEDLINE, EMBASE and PUBMED database searches were retrieved, and additional reports were collected by systematically reviewing all references. The number of women and the side of the lesion with respect to the falciform ligament of the liver were obtained from individual studies, and the combined frequency of right- and left-side diaphragmatic endometriosis was computed. In addition, seven personal cases were described. RESULTS: There were 16 reports including 47 subjects selected. Diaphragmatic endometriosis was on the right side in 31 (66%) patients, on the left in 3 (6%) and bilateral in 13 (27%). In the personal series, lesions were on the right side in five cases, on the left in one and bilateral in one. Considering only unilateral lesions, the observed proportion of right-sided endometriotic implants (36/40) was 90% (95% CI 76-97%; chi(2)(1) 32.6, P < 0.0001). CONCLUSIONS: The observed major asymmetry in diaphragmatic endometriotic lesion distribution in favour of the right leaf supports the menstrual reflux theory.

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Condition tags

mesh:D004715endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Endometriosis Menstruation Respiration Disorders Respiration Disorders Ascitic Fluid Ascitic Fluid Diaphragm Endometriosis Endometriosis Female Humans Respiration Disorders Respiration Disorders

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (50)

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License: CC0 · commercial use OK