Symptomatic diaphragmatic endometriosis ten years after total abdominal hysterectomy

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.