When Endometriosis Affects More Than the Pelvis
Endometriosis doesn’t just stay confined to the uterus or ovaries. For some, it spreads across multiple organ systems, affecting the lungs, diaphragm, bowels, ureters, and beyond. These cases require highly specialized, multidisciplinary care to fully excise disease and restore healthy function.
In this video, Dr. Karli Provost Goldstein, board-certified minimally invasive gynecologic surgeon, walks us through a complex excision surgery. With contributions from urologic and thoracic surgical partners, the operation addressed disease across the pelvic, abdominal, and thoracic cavities—all in a single, 9-hour procedure.
Understanding Multi-Organ Endometriosis
Advanced endometriosis, particularly Stage IV disease, can involve organs far beyond the reproductive system. This complex presentation requires expert diagnosis and specialized surgical teams working in perfect coordination.
Learn about endometriosis staging, from minimal superficial disease to severe cases with distant organ involvement including bowel, bladder, diaphragm, and lungs.
Key Surgical Challenges:
- Diaphragmatic and thoracic endometriosis: Inflammation and fenestrations (holes) in the diaphragm, along with endo involving the pleura (lining around the lungs), required careful excision and reconstruction.
- Frozen pelvis and bowel involvement: The rectum, sigmoid colon, and other bowel structures were fused from prior surgeries, necessitating full mobilization.
- Hydroureter and organ displacement: The ureter was five times its normal size due to blockage; the kidney had shifted position, and the liver had herniated into the chest cavity.
Comprehensive guide to thoracic endometriosis, including symptoms, diagnosis, and treatment of endometriosis that affects the chest, lungs, and diaphragm.
Surgical Strategy and Recovery Approach:
- The diaphragm and lung linings were cleared of endo and repaired.
- The ureter was successfully mobilized without needing a permanent reimplantation—avoiding years of stent dependency.
- A temporary stent, chest tube, pelvic drain, and Foley catheter were placed to support organ recovery and reduce inflammation.
Expert Care for Complex Cases
Dr. Goldstein’s fellowship training specifically focused on endometriosis with multi-organ involvement – one of very few such specialized programs worldwide. Her expertise in deep excision techniques and collaborative surgical approaches ensures comprehensive treatment for even the most complex presentations.
Read about Lisa’s frozen pelvis, emergency bowel complications, and multi-disciplinary recovery approach after Stage IV endometriosis surgery.
When You Need a Specialist
Too often, patients with multi-system endometriosis are told nothing more can be done. Complex symptoms affecting multiple organs require specialized evaluation and expert surgical teams.
