Excision of Diaphragmatic Endometriosis in Los Angeles

Comprehensive Care for Diaphragmatic Endometriosis

Diaphragmatic endometriosis is a rare and often underdiagnosed form of deep endometriosis in which tissue implants on or penetrates the diaphragm. At the Comprehensive Endometriosis Center in Los Angeles, excision is performed laparoscopically or with robotic assistance.

Excision of diaphragmatic endometriosis is a specialized surgical procedure that involves the careful removal of endometriotic lesions from the diaphragm. Due to the complexity and location of the disease, surgery often requires a multi-disciplinary approach, including collaboration between gynecologic and thoracic surgeons. At the Comprehensive Endometriosis Institute, we have the expertise and team-based model of care needed to treat even the most complex presentations of endometriosis, including rare cases involving the diaphragm and upper abdomen.

— Thoracic Endometriosis —

Understanding Diaphragmatic Endometriosis

Diaphragmatic endometriosis occurs when endometrial-like tissue implants on the surface or within the muscle fibers of the diaphragm. This tissue responds to hormonal fluctuations, just like endometrial tissue inside the uterus. During the menstrual cycle, it can bleed and trigger inflammation, leading to localized pain and scarring.

The right side of the diaphragm is most commonly affected, likely due to the flow of peritoneal fluid that carries endometrial cells upward through the abdominal cavity. However, lesions can also affect the left side or be bilateral. In more advanced cases, the disease can extend through the diaphragm and affect the pleura (lining of the lungs), potentially causing thoracic endometriosis syndrome.

Diaphragmatic endometriosis often coexists with pelvic endometriosis, though it may go undiagnosed for years if chest or shoulder symptoms are not recognized as related. Because it is located far from the reproductive organs, many patients are initially referred to neurologists, orthopedic specialists, or pulmonologists before a gynecologic cause is considered.

— Key Signs

Common Symptoms

The symptoms of diaphragmatic endometriosis can vary depending on the depth and location of the lesions. In some cases, they are subtle or mistaken for unrelated conditions. However, many patients describe cyclical symptoms that occur around the time of menstruation, which can be a key diagnostic clue.

Common symptoms include:

01

Right or left shoulder pain, often described as deep or radiating from under the ribs

02

Chest pain, pressure, or tightness that worsens during periods

03

Shortness of breath or difficulty breathing during menstruation

04

Pain referred to the neck, collarbone, or upper back

05

Occasional dry cough, hiccups, or a feeling of restriction in the upper abdomen

In rare cases, catamenial pneumothorax (lung collapse during menstruation) may occur when lesions on the diaphragm erode into the thoracic cavity. This is a sign of thoracic endometriosis and requires urgent evaluation.

Patients may also experience classic pelvic symptoms, such as painful periods, pelvic pressure, or pain with bowel movements, especially if endometriosis is present in multiple locations.

— Surgical Options —

Diagnosis of Diaphragmatic Endometriosis in Los Angeles

Diagnosing diaphragmatic endometriosis can be challenging due to its rarity and the non-specific nature of its symptoms. Many patients go years without a correct diagnosis, especially if shoulder or chest pain is not immediately linked to their menstrual cycle.

Imaging tools such as MRI or high-resolution ultrasound may suggest diaphragmatic involvement, but they are not always sensitive enough to detect small or superficial lesions. In many cases, diagnosis is made or confirmed at the time of laparoscopic surgery, when the diaphragm can be directly visualized and lesions mapped.

Clinical suspicion is key. Patients who report cyclical shoulder or chest pain—especially if they also have confirmed pelvic endometriosis—should be evaluated for possible diaphragmatic involvement. A thorough pre-operative workup helps the surgical team plan for appropriate access and involve additional specialists if needed.

Surgical Treatment: Excision of Diaphragmatic Lesions

The gold standard for treating diaphragmatic endometriosis is surgical excision. Unlike ablation or superficial cauterization, excision involves the complete removal of the endometriotic tissue, which leads to more effective and long-lasting relief of symptoms.

At the Comprehensive Endometriosis Institute, diaphragmatic excision is performed via laparoscopic or robotic-assisted surgery. This minimally invasive approach allows the surgical team to carefully explore the diaphragm and remove visible lesions while minimizing trauma to surrounding tissue.

The procedure typically involves:

Placement of laparoscopic ports for access to the upper abdominal cavity
Inspection of the diaphragm for lesions, nodules, or fibrotic tissue
Sharp dissection or laser-assisted removal of affected tissue
Hemostasis and possible placement of anti-adhesion agents

If the disease has penetrated the diaphragm or caused full-thickness defects, partial resection of the diaphragm may be necessary. This involves removing a portion of the muscle and repairing it with sutures. In such cases, a thoracic surgeon may be involved to assist with resection and ensure proper closure and lung protection.

In patients with concurrent thoracic symptoms or catamenial pneumothorax, additional evaluation of the chest cavity may be performed. This can involve video-assisted thoracoscopic surgery (VATS) in collaboration with a thoracic surgical team.

— Healing Process —

Recovery After Surgery

Recovery after excision of diaphragmatic endometriosis depends on the extent of the disease and whether partial resection or thoracic involvement was necessary. For most patients, the procedure is performed laparoscopically, and they can return home within 24 to 48 hours.

Typical recovery milestones include:

Pain relief is often noticeable within the first menstrual cycle post-surgery. However, full resolution of symptoms may take a few months as inflammation subsides and tissues heal. Patients are encouraged to follow post-operative guidelines closely and attend follow-up appointments to monitor recovery and symptom improvement.

In some cases, hormonal therapy may be used post-operatively to reduce the risk of recurrence, particularly if microscopic disease is suspected or full excision was not possible.

— Specialist Support

Why Specialized Care Matters

Diaphragmatic endometriosis is not only rare—it requires a highly specialized and coordinated approach to diagnosis and treatment. At the Comprehensive Endometriosis Institute, we bring together a team of experts in gynecologic, thoracic, and minimally invasive surgery to ensure that even the most complex cases are managed safely and effectively.

Because many patients with diaphragmatic disease also have pelvic or bowel involvement, our multidisciplinary team approach ensures that all affected organs are evaluated and treated in a single, comprehensive surgical session.

Our goal is to eliminate disease, relieve pain, restore normal function, and prevent future complications through expert surgical care and long-term follow-up.

— Treatment Decision —

Is Surgery Right for You?

If you are experiencing unexplained shoulder or chest pain that worsens around your period, or if imaging or prior surgery has suggested diaphragmatic involvement, it’s time to consider evaluation by a team experienced in complex endometriosis care.

Surgical excision offers the best chance of long-term relief and disease control, especially when performed early and comprehensively. Don’t let rare symptoms go ignored—many patients find that finally receiving a diagnosis and proper treatment for diaphragmatic endometriosis is life-changing.

To learn more or schedule a consultation, reach out to the Comprehensive Endometriosis Institute. We are here to listen, to investigate, and to offer expert, whole-body care tailored to your unique experience.