Health

Unveiling the Rare Connection: Diaphragmatic Endometriosis Discovered During Surgery

2025-07-03

Author: Nur

What is Endometriosis?

Endometriosis occurs when tissue similar to the lining inside the uterus begins to grow outside the uterine cavity. It predominantly affects women between the ages of 25 to 35, impacting roughly 5-10% of those in their reproductive years. In adolescents aged 12 to 20, the prevalence can soar to 13%, and among those experiencing pelvic pain, this rate can escalate to as high as 65%.

The Rarity of Diaphragmatic Endometriosis

While endometriosis mainly targets pelvic organs like ovaries and uterine ligaments, it can exceptionally extend to extrapelvic sites, complicating diagnosis and treatment. Diaphragmatic endometriosis, a rare form of this condition, manifests with endometrial tissue around the lungs, often found on the right side of the diaphragm.

A Case Study: From Cholecystectomy to Diagnosis

In a fascinating case, a 22-year-old woman sought help for nonspecific upper abdominal pain, which led to an ultrasound indicating gallstones. During a laparoscopic cholecystectomy, doctors stumbled upon a nodule on her diaphragm and multiple endometriotic lesions in the pelvic region. Histopathological analysis confirmed that these nodules were indeed endometriosis.

Surgical Findings and Post-Operative Journey

The surgical team, while focusing on gallstones, discovered the diaphragmatic nodule and other endometriosis sites. A bipolar electrosurgery technique was employed to cauterize the lesions on the diaphragm, and subsequent imaging revealed ongoing endometriosis activity.

Navigating Treatment Options

Following surgery, the patient faced residual endometriosis and opted against further invasive procedures. Instead, she began hormonal treatment with leuprorelin acetate, eventually leading to significant regression of the endometriosis lesions and complete alleviation of right hypochondrium pain.

Understanding the Complexity of Diagnosis

Diaphragmatic endometriosis is often asymptomatic, making it a diagnostic challenge that can sometimes lead to incidental discoveries during surgeries for other conditions. This highlights the importance of thorough imaging and evaluations prior to invasive treatments.

What Makes Diaphragmatic Endometriosis Unique?

The condition may stem from various origins, including theories like retrograde menstruation or lymphatic dissemination, but its exact cause remains unclear. Interestingly, the right side of the diaphragm is more frequently affected, believed to be due to anatomical factors.

Looking Towards the Future: Managing Endometriosis

Postoperative care for diaphragmatic endometriosis remains nuanced, as hormonal therapies may slow progression or alleviate symptoms. Cases like this shine a light on the necessity of personalized care approaches involving multidisciplinary teams to enhance treatment outcomes.

Conclusion: A Rare Yet Significant Discovery

This patient's unexpected diagnosis of diaphragmatic endometriosis during gallbladder surgery emphasizes the need for vigilance in evaluating seemingly unrelated symptoms. The combination of surgical intervention followed by targeted hormonal therapy proves effective in managing both pelvic and diaphragmatic endometriosis, paving the way for further understanding of this rare condition.