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J Gynecol Obstet Hum Reprod. 2019 Mar 18. pii: S2468-7847(18)30480-X. doi: 10.1016/j.jogoh.2019.03.006. [Epub ahead of print]

Non-traumatic diaphragmatic rupture with liver herniation due to endometriosis: A rare evolution of the disease requiring multidisciplinary management.

Author information

1
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, Department of Obstetrics and Gynecology, Avenue Côte de Nacre, 14000 Caen, France. Electronic address: leo.gaichies@gmail.com.
2
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, Department of Radiology, Avenue Côte de Nacre, 14000 Caen, France.
3
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, Department of Pathology, Avenue Côte de Nacre, 14000 Caen, France.
4
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, Department of Obstetrics and Gynecology, Avenue Côte de Nacre, 14000 Caen, France.
5
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, Department of Thoracic Surgery, Avenue Côte de Nacre, 14000 Caen, France.
6
Normandie Univ, UNICAEN, 2 rue des Rochambelles, CHU de Caen Normandie, INSERM U1086 BioTICLA, Department of Obstetrics and Gynecology, Avenue Côte de Nacre, 14000 Caen, France.

Abstract

A 35 year old woman with chronic pelvic endometriosis suffered from right scapular pain. MRI imaging showed a right diaphragmatic rupture with liver herniation. Surgical procedure was performed by thoracotomy. The liver was put back into the abdomen, endometriosis was resected from the diaphragm, interrupted non absorbable suture of the diaphragm was performed and an absorbable mesh was placed. Endometriosis was confirmed on histological analysis of the resected diaphragm. To study this pathology, we performed a systematic review of the literature and found 12 similar cases of diaphragmatic rupture due to endometriosis. Right diaphragm is often involved and rupture is always located on the tendinous portion. Symptoms are mainly cyclic right scapular pain and cathamenial pneumothorax. MRI should be performed in case of suggestive symptoms and a systematic exploration of the diaphragm should be performed at laparoscopy for an early treatment of the lesions to prevent progression to rupture.

KEYWORDS:

Diaphragmatic endometriosis; Diaphragmatic rupture; Thoracic endometriosis

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