Department of Obstetrics and Gynecology, Kanazawa University School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
Arch Gynecol Obstet. 2012 Aug;286(2):411-4. doi: 10.1007/s00404-012-2313-7. Epub 2012 Apr 6.
Severe hemothorax is a rare complication after laparoscopic surgery for endometriosis, and the causes and proper management are not well understood.
We report here the extremely rare case with massive hemothorax after laparoscopic surgery for ovarian endometrioma. A 40-year-old woman, gravida 1, para 1, underwent laparoscopic cystectomy of ovarian endometrioma. On postoperative day 2, she had progressive anemia (Hb 5.3) as well as dyspnea. A chest X-ray and computed tomography showed massive fluid collection in the right thoracic cavity, suggestive of intrapleural bleeding.
Thoracoscopic operation was performed and a total of 930 ml of blood retention in the right thoracic cavity was found. Scattered small endometriotic lesions were present on the pleural surface of the right diaphragm; pulsatile active bleeding was confirmed from one of these. Furthermore, two endometriotic lesions had perforated into the intraperitoneal cavity. The diaphragm containing bleeding spots was thoracoscopically resected and sutured. After thoracoscopic surgery, the dyspnea and anemia resolved. On postoperative day 5, the patient left the hospital.
The present report reminds us of the importance of paying special attention to postoperative-thoracic complications caused by diaphragmatic endometriosis if the patient shows respiratory symptoms.
腹腔镜子宫内膜异位症手术后发生严重血胸是一种罕见的并发症，其病因和适当的处理方法尚不清楚。
我们在此报告一例极其罕见的腹腔镜卵巢子宫内膜异位囊肿手术后发生大量血胸的病例。一名 40 岁的初产妇 1 行腹腔镜卵巢子宫内膜异位囊肿切除术。术后第 2 天，她出现进行性贫血（Hb 5.3）和呼吸困难。胸部 X 线和 CT 显示右侧胸腔大量积液，提示胸腔内出血。
进行了胸腔镜手术，发现右侧胸腔内共积血 930ml。右侧膈肌的胸膜表面有散在的小子宫内膜异位病灶；其中一个病灶有搏动性活动性出血。此外，有两个子宫内膜异位病灶穿孔进入腹腔。胸腔镜下切除并缝合含出血点的膈肌。胸腔镜手术后，呼吸困难和贫血得到缓解。术后第 5 天，患者出院。
本报告提醒我们，如果患者出现呼吸系统症状，应特别注意由膈子宫内膜异位症引起的术后胸部并发症。
