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Cited by 91Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Asymmetry in distribution of diaphragmatic endometriotic lesions: evidence in favour of the menstrual reflux theory

Vercellini, P., Abbiati, A., Vigano, P., Somigliana, E.D., Daguati, R., Meroni, F., Crosignani, P.G.·2007·Human Reproduction
DOI 10.1093/humrep/dem224
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Abstract

BACKGROUND: If the menstrual reflux or implantation theory of endometriosis is true, refluxed endometrial cells could reach the right hypochondrium transported by the clockwise peritoneal fluid current and would implant more easily on the right diaphragmatic leaf as they are stuck there by the falciform ligament. METHODS: To investigate if a lateral asymmetry exists in diaphragmatic endometriotic lesion distribution, all articles on diaphragmatic endometriosis identified by MEDLINE, EMBASE and PUBMED database searches were retrieved, and additional reports were collected by systematically reviewing all references. The number of women and the side of the lesion with respect to the falciform ligament of the liver were obtained from individual studies, and the combined frequency of right- and left-side diaphragmatic endometriosis was computed. In addition, seven personal cases were described. RESULTS: There were 16 reports including 47 subjects selected. Diaphragmatic endometriosis was on the right side in 31 (66%) patients, on the left in 3 (6%) and bilateral in 13 (27%). In the personal series, lesions were on the right side in five cases, on the left in one and bilateral in one. Considering only unilateral lesions, the observed proportion of right-sided endometriotic implants (36/40) was 90% (95% CI 76-97%; chi(2)(1) 32.6, P < 0.0001). CONCLUSIONS: The observed major asymmetry in diaphragmatic endometriotic lesion distribution in favour of the right leaf supports the menstrual reflux theory.

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Crossref · 10.1093/humrep/dem224

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113 of 113 references verified0 citation errors · 0 not checkable

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  • The asymmetric distribution of ectopic endometrium in the diaphragm as described by Vercellini et al. is confirmed in this case.

    “The asymmetric distribution of ectopic endometrium in the diaphragm as described by Vercellini et al. [36] is confirmed in this case.”

    From Pericardial, pleural and diaphragmatic endometriosis in association with pelvic peritoneal and bowel endometriosis: a case report and review of the literature. (2012) · cites this paper as [36]

  • The most plausible theory for diaphragmatic endometriosis is retrograde menstruation with subsequent transportation of viable cells in peritoneal fluid from the pelvis up the right gutter to the right hemidiaphragm, explaining its asymmetric distribution.

    “The most plausible theory about this condition is based on retrograde menstruation and subsequent transportation of viable cells in peritoneal fluid from the pelvis up the right gutter to the right hemidiaphragm, thus demonstrating its asymmetric distribution on the diaphragm.”

    From Pericardial, pleural and diaphragmatic endometriosis in association with pelvic peritoneal and bowel endometriosis: a case report and review of the literature. (2012) · cites this paper as [36]

  • This condition describes the presence of more dense endometrial implants in the right hemidiaphragm than in the left side, in accordance with transportation of viable cells in peritoneal fluid following a clockwise circulation pattern from the pelvis up the right gutter to the right hemidiaphragm; the cells are then blocked by the falciform ligament, and over time infiltrate the right half of the肉

    “This condition describes the presence of more dense endometrial implants in the right hemidiaphragm than in the left side, in accordance with the transportation of viable cells in peritoneal fluid following a clockwise circulation pattern from the pelvis up the right gutter to the right hemidiaphragm; the cells are then blocked by the falciform ligament, and over time infiltrate the right half of”

    From Pericardial, pleural and diaphragmatic endometriosis in association with pelvic peritoneal and bowel endometriosis: a case report and review of the literature. (2012) · cites this paper as [36]

  • The retrograde menstruation theory is the most plausible explanation for how endometrial cells reach the thoracic cavity, as it can explain the role of diaphragmatic endometrial implants.

    “Of these, the retrograde menstruation theory is the most plausible, as it can explain the role of diaphragmatic endometrial implants”

    From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [77]

  • The peritoneal fluid is deviated away from the left hemidiaphragm due to obstruction by the falciform ligament of the liver.

    “Instead, the peritoneal fluid is deviated away from the left hemidiaphragm due to obstruction by the falciform ligament of liver.”

    From Extra-pelvic endometriosis: a review. (2020) · cites this paper as [77]

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Authors
Vercellini, P., Abbiati, A., Vigano, P., Somigliana, E. D., Daguati, R., Meroni, F., & Crosignani, P. G.
Affiliations
University of Milan (IT)
Corresponding author
Vercellini, P.
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2007-06-28
Volume
22
Issue
9
Pages
2359-2367
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dem224
OpenAlex
W2123446124
Cited by
91
References
113
Citations by year
2026: 5 · 2025: 5 · 2024: 9 · 2023: 11 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 2 · 2016: 6 · 2015: 1 · 2014: 3 · 2013: 2 · 2012: 6
FWCI
4.78
Type
journal article
Language
en
Open access
closed
Locations
  • Human Reproduction (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
diaphragmatic endometriosis, endometriosis, lateral asymmetry, falciform ligament, right hypochondrium, lesion distribution
MeSH terms
Ascitic Fluid, Diaphragm, Endometriosis, Female, Humans, Menstruation, Respiration Disorders

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