Symptomatic diaphragmatic endometriosis ten years after total abdominal hysterectomy

Barak Nahir, Nahir B, Talia Eldar-Geva, Eldar-Geva T, Alberton J, Joseph Alberton, Beller U, Uzi Beller
Obstetrics and gynecology · 2004 · doi:10.1097/01.AOG.0000125000.20582.64 · PMID:15516432
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This case report describes a 50-year-old woman who developed symptomatic diaphragmatic endometriosis ten years after hysterectomy, highlighting the condition as a differential diagnosis for right upper-quadrant pain in women with a single functioning ovary.

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This case report describes a 50-year-old woman presenting with right upper-quadrant pain ten years after undergoing a total abdominal hysterectomy and right salpingo-oophorectomy for uterine leiomyomas. Diagnostic imaging identified a lesion in the diaphragm, which was surgically excised and pathologically confirmed to be an endometriotic cyst containing chocolate-colored material. The authors note that while diaphragmatic involvement is extremely uncommon, particularly in the absence of pelvic disease years after surgery, it should remain a consideration in the differential diagnosis for symptomatic lesions in women with a single functioning ovary. This paper is centrally about endometriosis — specifically the rare presentation of symptomatic diaphragmatic endometriosis occurring long after definitive pelvic surgery.

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Abstract

BACKGROUND: Endometriosis is a disease that affects women, mostly in the age range of 25-35 years, and in most cases pelvic organs are involved. Involvement of the diaphragm after hysterectomy is extremely uncommon. CASE: A 50-year-old woman presented to our department with right upper-quadrant abdominal pain. Ten years before her admission, she underwent total hysterectomy and right salpingo-oophorectomy for a large leiomyomatous uterus. On evaluation, a right diaphragmatic lesion was identified by computed tomography. An explorative laparotomy was then performed, which revealed a 4-cm diaphragmatic cyst compressing the liver surface and containing thick chocolate-colored material. The lesion was totally excised. Pathological examination confirmed the diagnosis of endometriotic cyst. CONCLUSION: The diagnosis of endometriosis involving the diaphragm with no evidence of disease in the pelvis 10 years after hysterectomy, although a rare situation, should be considered in the differential diagnosis of a symptomatic diaphragmatic lesion in a woman with a single functioning ovary.
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Background

Endometriosis is a disease that affects women, mostly in the age range of 25–35 years, and in most cases pelvic organs are involved. Involvement of the diaphragm after hysterectomy is extremely uncommon. CASE: A 50-year-old woman presented to our department with right upper-quadrant abdominal pain. Ten years before her admission, she underwent total hysterectomy and right salpingo-oophorectomy for a large leiomyomatous uterus. On evaluation, a right diaphragmatic lesion was identified by computed tomography. An explorative laparotomy was then performed, which revealed a 4-cm diaphragmatic cyst compressing the liver surface and containing thick chocolate-colored material. The lesion was totally excised. Pathological examination confirmed the diagnosis of endometriotic cyst.

Conclusion

The diagnosis of endometriosis involving the diaphragm with no evidence of disease in the pelvis 10 years after hysterectomy, although a rare situation, should be considered in the differential diagnosis of a symptomatic diaphragmatic lesion in a woman with a single functioning ovary.

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Condition tags

endometriosisthoracic_endometriosis

MeSH descriptors

Endometriosis Hysterectomy Leiomyoma Abdominal Pain Abdominal Pain Abdominal Pain Biopsy, Needle Cysts Cysts Diaphragm Diaphragm Endometriosis Endometriosis Female Follow-Up Studies Humans Hysterectomy Hysterectomy Immunohistochemistry Laparotomy

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europepmc
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pubmed
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