Coagulation-Induced Diaphragm Fenestrations after Laparoscopic Excision of Diaphragmatic Endometriosis

Nirgianakis K, Konstantinos Nirgianakis, Lanz S, Susanne Lanz, Imboden S, Sara Imboden, Mathias Worni, Michael D Mueller, Mueller MD
Journal of minimally invasive gynecology · 2017 · vol. 25(5) , pp. 771–772 · doi:10.1016/j.jmig.2017.10.028 · PMID:29097233 · W2766463754
article OA: closed CC0 ⤵ 6 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This paper describes the occurrence of diaphragm fenestrations caused by blood clotting following laparoscopic surgery for endometriosis.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

Study objectiveTo present an unusual consequence of laparoscopic treatment of diaphragmatic endometriosis, to discuss the possible etiologies, and to propose proper management.DesignA step-by-step explanation of 2 surgeries of the same patient using intraoperative video sequences (Canadian Task Force classification III).SettingUniversity hospital.PatientA 32-year-old woman.InterventionsTwo Laparoscopic surgeries.Measurements and main resultsEndometriosis is estimated to affect 11% of the population [1,2], with an estimated 12% of these patients having extrapelvic endometriosis [3]. When the diaphragm is involved, the disease potentially causes severe and debilitating symptoms such as catamenial chest or shoulder pain. Serious complications may involve pneumothorax and hemopneumothorax [4-6]. Diaphragmatic endometriosis is more common than realized and has been shown to occur simultaneously in 50% to 80% of cases with pelvic endometriosis [7,8]. A 32-year-old woman was admitted to our hospital with severe disabling dysmenorrhea and right shoulder pain. Despite progestin, nonsteroidal anti-inflammatory drug, and opioid treatment, pain relief remained inadequate. A laparoscopy was performed revealing diaphragmatic endometriosis, which was completely excised. A revision was necessary 14 months later because of pain recurrence in the right hemithorax and suspicion of new or persistent endometriotic lesions. The laparoscopy revealed small diaphragm fenestrations that were closed after exclusion of recurrent diaphragmatic or pleural endometriosis. No chest tube was placed, and the postoperative course was uneventful. Hormonal suppressive treatment was continued. Since the operation the patient has been pain free. Institutional Review Board/Ethics Committee ruled that approval was not required for this study (Req-2017-00415).ConclusionThe diaphragm fenestrations were possibly the result of tissue necrosis caused by thermocoagulation after excision of deep endometriotic lesions during the first surgery. Using a CO2 laser for the vaporization of superficial lesions is favorable because of the smaller depth of penetration compared with electrocautery and better access to hard to reach areas [9,10]. Endometriotic lesions involving the entire thickness of the diaphragm should be completely excised and the defect repaired with either sutures or staples [11-13].

My notes (saved in your browser only)

Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Diaphragm Endometriosis Laparoscopy Laser Coagulation Muscular Diseases Adult Diaphragm Diaphragm Endometriosis Endometriosis Female Humans Laparoscopy Laparoscopy Laser Coagulation Muscular Diseases Muscular Diseases Pain Pain

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 (13)

Cited by (6)

SciLite annotations

chemicals 2
progestin opioid analgesic

Source provenance

europepmc
last seen: 2026-07-26T06:08:39.051465+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:20:13.663096+00:00
scilite
last seen: 2026-05-18T04:25:29.313245+00:00
License: CC0 · commercial use OK