Extrapelvic Endometriosis: A Systematic Review.
Level 4 - case-series / case-control
Systematic review consisting predominantly of case reports and retrospective case series.
PubMed 31618674 · doi:10.1016/j.jmig.2019.10.004
What was done
Authors conducted a systematic review searching PubMed/Medline, Embase, and Cochrane databases over a 20-year period for studies on primary extrapelvic deep endometriosis (PROSPERO CRD42019125370). From 5,465 initial search results, 179 articles (predominantly case reports and series) were analyzed for lesion location, clinical presentation, diagnostic approach, surgical and medical management, complications, and recurrence rates.
What was found
The review identified articles reporting on parietal (230), visceral (43), thoracic (628), central nervous system (6), muscle/nerve (12), and nasal (1) endometriosis. Parietal abdominal lesions presented with a palpable mass (99%), cyclic pain (71%), and cyclic bleeding (48%); wide local excision was performed in 97%, with a 5% recurrence rate and zero complications. Visceral abdominal cases involved kidney, liver, pancreas, and biliary tract; 86% underwent surgery (51% conservative, 49% radical resection) with 15% recurrence and 2 major complications. Thoracic endometriosis favored the right side (80%), presenting with catamenial pain, pneumothorax, and hemoptysis; thoracoscopy with resection and pleurodesis was most common, with 29% recurrence and 15% receiving adjuvant gonadotropin-releasing hormone therapy. Nonthoracic and nonabdominal cases presented with paresthesia and cyclic radiating pain; 84% underwent surgical resection with symptom improvement.
Why it matters
Extrapelvic endometriosis is frequently overlooked or misdiagnosed due to presentation outside the pelvis. This review synthesizes clinical presentations and post-surgical recurrence rates across anatomical sites to assist multidisciplinary diagnostic suspicion and management.
Limits
The included literature consists almost exclusively of retrospective case reports and uncontrolled series, carrying high risks of selection and publication bias. There were no comparative or randomized trials to assess optimal diagnostic methods or determine comparative efficacy between medical and surgical interventions.
Cited by
- supports Endometriosis implants can occur in extra-pelvic anatomical sites, including the diaphragm, lungs, and brain.