5 “Strange” Places Where Endometriosis Occurs

Endometriosis is the formation of lesions resembling the tissue lining the uterus outside the uterus. These lesions usually form in the pelvic cavity. However, in some rare instances, they can spread to other areas outside the pelvic cavity and be called extra-pelvic endometriosis. Here are 5 “strange” places where endometriosis can occur.

In the thorax

In thoracic endometriosis, lesions may spread to the diaphragm and even to the lungs, trachea, and the pericardium surrounding the heart. Thoracic endometriosis can be very dangerous as it may cause the air in the lungs to “leak” outside the lungs and into the pleural space leading to partial or complete lung collapse.

The diagnosis of thoracic endometriosis is challenging. Many doctors do not associate symptoms such as chest pain and breathing difficulties with endometriosis.

In and around the C-section scar

C-section scar endometriosis is a rare form of the disease which is very rare. Here lesions grow in the scar or incision site of a Cesarean section performed for delivery. 

There is not much information as to how this form of endometriosis develops. Research suggests that hormones or the wound environment may contribute.

The contamination of the incision site with endometrial lesions can also lead to disease progression.

Laparoscopic deep excision surgery followed by histological examination is the only way to confirm C-section scar endometriosis.

In the liver and upper right quadrant

Liver or hepatic endometriosis is among the rarest forms of extra-pelvic endometriosis with only a handful of cases in literature. The upper right quadrant is the most affected region leading to abdominal pain in this area and progression to jaundice. Liver endometriosis can also be associated with thoracic endometriosis.

Diagnosis of liver endometriosis is not straightforward and requires differential diagnosis to rule out other liver diseases such as hepatitis and cancer.

Around the sciatic nerve

Endometriosis lesions can also grow around nerves and cause neuropathy. Sciatic endometriosis happens when endometriosis lesions start growing on the sciatic nerve. This is the nerve that connects the spinal cord with the lower limbs. The lesions compress the nerve leading to pain in the pelvis and lower limbs. 

Similarly, endometriosis can also affect the pudendal nerve that controls the anal and urethral sphincters. An early diagnosis of sciatic endometriosis is essential to avoid damage to the sciatic nerve. Complicating diagnosis is the fact that symptoms of sciatic endometriosis are more or less similar to sciatica. 

In the umbilicus

Endometriosis in the umbilicus or belly button is rare and is characterized by a painful, discolored swelling. It can be difficult to distinguish umbilical endometriosis from other nodules such as umbilical hernias. However, unlike umbilical hernias, pain caused by umbilical endometriosis usually coincides with monthly cycles. In some cases, the umbilicus may even bleed during menstruation.

In most cases, women who experience extra-pelvic endometriosis also have endometriosis in the pelvis.

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