Department of Obstetrics and Gynecology, Toho University, Tokyo, Japan.
Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan.
J Obstet Gynaecol Res. 2022 Apr;48(4):1039-1045. doi: 10.1111/jog.15175. Epub 2022 Feb 15.
Porous diaphragm syndrome includes all pleural cavity conditions, including pleural effusion, hemothorax, or pneumothorax, that occur secondary to peritoneal cavity disorders through defects in the diaphragm. In this report, we describe the first known case of porous diaphragm syndrome presenting as hemothorax after laparoscopic myomectomy. A 46-year-old nulliparous woman underwent laparoscopic myomectomy for multiple fibroids. Eight hours after surgery, the patient developed exertional dyspnea followed by hemoptysis. Radiological diagnosis revealed massive hemothorax in the right thoracic cavity. Thoracoscopic findings showed the presence of small fenestrae at the center of the right diaphragm, which were repaired thoracoscopically. Hence, quick postoperative diagnosis resulted in successful treatment. In this case, porous diaphragm syndrome is believed to be caused by retention of intraoperative bleed and saline from intra-abdominal lavage, in the abdominal cavity. Porous diaphragm syndrome is a potential life-threatening condition that gynecological surgeons should consider in this era of laparoscopic surgery.
多孔隔膜综合征包括所有胸膜腔情况，包括胸腔积液、血胸或气胸，这些情况是由于膈膜缺陷继发于腹腔疾病。在本报告中，我们描述了首例已知的多孔隔膜综合征病例，表现为腹腔镜子宫肌瘤剔除术后的血胸。一名 46 岁的未产妇因多发性子宫肌瘤接受了腹腔镜子宫肌瘤剔除术。手术后 8 小时，患者出现劳力性呼吸困难，随后出现咯血。放射学诊断显示右侧胸腔大量血胸。胸腔镜检查发现右膈肌中央有小窗孔，经胸腔镜修复。因此，快速的术后诊断导致了成功的治疗。在这种情况下，多孔隔膜综合征被认为是由术中出血和腹腔内灌洗的生理盐水在腹腔内潴留引起的。多孔隔膜综合征是一种潜在的危及生命的疾病，妇科外科医生在腹腔镜手术时代应予以考虑。
