September 19, 2023 | by Tamer Seckin, MD
The liver is among the most important organs of the body and is responsible for many metabolic processes. It also acts as a detoxifying organ, removing toxins from the bloodstream. Liver endometriosis, or hepatic endometriosis, is the presence of endometriosis lesions on the liver. Isolated cases of hepatic endometriosis are among the rarest forms of extra-pelvic endometriosis, with only about 28 cases in the literature so far. However, endometriosis affecting the liver and the upper right quadrant is more common.
What is liver endometriosis?
The first scientists to describe liver endometriosis were Finkel and colleagues in 1986.
Liver endometriosis can cause pain in the right upper part of the abdomen and lead to nausea and vomiting. The disease can affect both lobes of the liver and cause the formation of clots in the portal vein with rapid progression of jaundice. Most often, endometriosis affects the entire upper right quadrant rather than only the liver.
Endometriosis affecting the upper right quadrant and the liver may be asymptomatic. However, it may be associated with adhesions and diaphragmatic implants, which can lead to thoracic endometriosis.
The exact mechanisms underlying hepatic endometriosis are unclear. Commonly accepted theories include lymphatic spread, retrograde menstruation, and hematogenic spread, among others, affecting the upper right quadrant as a whole.
Summary
Liver endometriosis, or hepatic endometriosis, involves the presence of endometriosis lesions on the liver, making it one of the rare forms of extra-pelvic endometriosis. While isolated cases are uncommon, lesions affecting the upper right quadrant of the abdomen are more prevalent. Symptoms may include abdominal pain, nausea, and jaundice, and diagnosis typically involves imaging techniques such as CT, ultrasound, and MRI, alongside blood tests for differential diagnosis.
Treatment options remain unclear for asymptomatic cases, but laparoscopic excision is preferred for symptomatic patients. Careful removal of lesions is essential, particularly when associated with other complications like diaphragmatic implants.
How to diagnose?
The diagnosis of hepatic endometriosis in reported cases involved imaging techniques such as CT, ultrasound, and MRI. However, imaging tests are not conclusive in deciding whether it is an endometriosis lesion or a tumor.
Supporting tests for differential diagnosis of other liver disorders include blood counts, hepatitis B surface antigen, and anti-hepatitis C virus antibodies.
Unless they are symptomatic or presenting with a large mass, major surgery is not necessary. After determining the segment in which the lesions are located, a laparoscopic partial hepatectomy and histological examination of the specimen can confirm the presence of endometriosis.
Although extremely rare, there have been a few cases of malignant transformation of hepatic endometriosis. So, testing for cancer markers such as CA-199, CA-125, carcinoembryonic antigen, and alpha-fetoprotein may also be necessary.
How to treat?
Currently, there is no consensus on treatment options for asymptomatic liver endometriosis. It is not clear whether the ectopic endometriosis lesions can penetrate deep into the liver tissue.
If symptoms are present, laparoscopic excision will facilitate complete removal of the lesion compared with heat or laser ablation. Most cases of hepatic endometriosis are not isolated. Therefore, meticulous removal of each lesion, including diaphragm lesions, is necessary to ensure the patient receives appropriate treatment.
FAQ
What is liver endometriosis?
Liver endometriosis, or hepatic endometriosis, is the presence of endometriosis lesions on the liver, affecting the upper right quadrant of the abdomen.
How is liver endometriosis diagnosed?
Diagnosis typically involves imaging techniques like CT, ultrasound, and MRI, along with blood tests to differentiate it from other liver disorders.
What are the symptoms of liver endometriosis?
Symptoms may include pain in the right upper abdomen, nausea, vomiting, and in some cases, jaundice due to complications.
What treatment options are available for liver endometriosis?
Treatment options vary; if symptomatic, laparoscopic excision is preferred for complete removal of lesions, while asymptomatic cases may not require immediate intervention.
Is liver endometriosis common?
Liver endometriosis is rare, with only about 28 documented cases, but endometriosis affecting the upper right quadrant is more prevalent.
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