Endometriosis in the liver is one of the rarest types of endometriosis outside the pelvis. Treatment may include hormone therapy and surgery to remove the affected areas of the liver.

Endometriosis is a condition in which tissue similar to the endometrium, the lining of the uterus, grows outside the uterus in other areas of the body. It usually affects areas within the pelvis.

However, rarely, endometriosis may spread to the liver. This article looks at the symptoms, diagnosis, treatment, and outlook for liver endometriosis.

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Endometriosis most commonly affects areas within the pelvis, including the:

  • uterus
  • fallopian tubes
  • ovaries

There have been reports of endometriosis in most other organs outside the pelvis, including the lungs, gastrointestinal tract, and kidneys.

Researchers are unclear on how frequently endometriosis occurs outside the pelvis, but some suggest it may affect females between the ages of 34 and 40 years.

According to a 2020 review, the liver is one of the rarest areas of the body for endometriosis to spread outside of the pelvis.

Researchers are not clear how endometrial cells spread to the liver, but one theory suggests it may spread through the lymphatic system.

According to a 2019 review of people with liver endometriosis, a significant number have had previous surgery on their abdominal or pelvic areas. This included a hysterectomy in 41% of those reviewed, and pelvic surgery in 51% of those reviewed.

During surgery, accidental misplacement of endometrial tissue from the uterus to another area of the body may cause endometriosis and may play a role in liver endometriosis.

So far, scientific reviews suggest there have been between 22 and 29 reports of people with liver endometriosis, with the first report in 1986.

A 2019 review and case report details a 42-year-old female with liver endometriosis, who experienced the following symptoms:

Most people may experience upper abdominal pain.

Some people may experience cyclic pain in relation to menstruation, which is a typical symptom of endometriosis. Some people may not experience any symptoms.

Treatment for endometriosis may include hormone medications or surgery.

Some people may need surgery to remove part of the liver tissue which is affected by endometrial lesions.

This may be necessary if a doctor suspects lesions may be cancerous, if liver endometriosis is causing other health issues, or if symptoms are persistent.

Surgery may involve laparoscopic surgery, in which a surgeon operates through a small incision in the abdomen, or it may be open surgery.

As part of the diagnostic process, doctors may use imaging scans to examine the liver, such as:

Diagnosing liver endometriosis can be challenging, as on imaging scans, endometrial lesions may look similar to other conditions, such as an abscess or a cyst.

Even with these scans, doctors may not be able to identify any distinct features to make a definitive diagnosis of liver endometriosis.

To make a definitive diagnosis, a medical professional must examine the cells or tissues under a microscope. A doctor may collect these samples during a biopsy or surgery.

Endometriosis is a benign condition, but symptoms may negatively affect a person’s quality of life.

It is rare for endometriosis to become cancerous, and only occurs in fewer than 1% of people with the condition. Most of the time, the cancerous condition starts in the ovaries.

Treatment may help resolve liver endometriosis. A 2019 case report found that treating the individual with surgery to remove part of their liver, followed by a regimen of medroxyprogesterone acetate, a type of hormonal therapy, was effective.

After 2 months of follow-ups, the person was well, with no symptoms and normal liver tests.

According to a 2020 review, surgery for liver endometriosis with an experienced surgeon is a safe and effective treatment option. Laparoscopic surgery is the standard treatment for lesions in the liver and may improve short and long-term outcomes.

Out of the included case studies, liver endometriosis only recurred in one person. There was only one report of a complication after surgery, which was a bile leak. There were no reports of severe events due to surgery.

This section answers some frequently asked questions about liver endometriosis.

Can a doctor mistake endometriosis for fatty liver?

Endometriosis in the liver is very rare, and endometriosis and fatty liver have different diagnostic methods.

Fatty liver does not usually cause any symptoms, but people may experience fatigue and pain in their upper right abdomen.

Liver endometriosis can also cause upper right abdominal pain. If people experience this, they can contact a doctor who can test for what may be causing symptoms.

Can endometriosis cause fatty liver?

There appears to be no clear link between endometriosis and fatty liver, although they may share some similar risk factors.

Increased levels of estrogen may increase the risk of developing endometriosis. Higher amounts of body fat, excess alcohol, and high doses of estrogen in medication may raise estrogen levels.

Factors that may increase the risk of fatty liver include overweight or obesity, excess alcohol, and estrogen medications.

Endometriosis usually affects the area within the pelvis, and endometriosis in the liver is very rare.

People may experience upper right abdominal pain with liver endometriosis. Other symptoms may include nausea, vomiting, or cyclical pain with menstruation.

Treatment for liver endometriosis may include surgery to remove the affected areas of the liver and hormone therapy. Case reports suggest positive outcomes for liver endometriosis treatments.