VATS and hormonal therapy for diaphragmatic endometriosis in a 42-year-old woman with hepatic herniationCan surgery alone fix rare chest pain caused by endometriosis, or is a team approach needed?

This case report and review of literature focuses on a 42-year-old woman presenting with diaphragmatic endometriosis, hepatic herniation, and catamenial pneumothorax. The patient had a long history of cyclical thoracic pain associated with these rare manifestations of extrapelvic endometriosis. Diagnostic complexity and the progressive nature of the disease were noted as significant challenges in this setting.

The patient received video-assisted thoracoscopic surgery (VATS) with diaphragmatic reconstruction, followed by a subsequent VATS procedure involving pleurectomy and pleural abrasion. Hormonal therapy was also administered as part of the management strategy. The primary outcome of symptom control showed partial improvement, while long-term disease control remained a secondary goal that required ongoing attention.

Safety considerations included the recurrence or persistence of catamenial pneumothorax, which was listed as an adverse event. The case underscores that surgical repair alone may be insufficient in cases with significant thoracic involvement. Limitations of the evidence include the single-case nature of the report and the inherent diagnostic difficulties associated with this rare condition.

The practice relevance emphasizes the importance of early multidisciplinary collaboration between gynecologic and thoracic specialists. Coordinated management is essential to improve long-term disease control and address the severe complications that may arise from diaphragmatic rupture or herniation. Clinicians should recognize that extrapelvic endometriosis requires a tailored, collaborative approach rather than isolated intervention.