{"paper_id":"317f2f23-3cd1-4f11-bad3-525174520d67","body_text":"Abstract\nBackground\nSevere hemothorax is a rare complication after laparoscopic surgery for endometriosis, and the causes and proper management are not well understood.\nCase\nWe 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.\nTreatment\nThoracoscopic 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.\nConclusion\nThe 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.\nSimilar content being viewed by others\nReferences\nJoseph J, Reed CE, Sahn SA (1994) Thoracic endometriosis. Recurrence following hysterectomy with bilateral salpingo-oophorectomy and successful treatment with talc pleurodesis. Chest 106:1894–1896\nAlifano M, Trisolini R, Cancellieri A, Regnard JF (2006) Thoracic endometriosis: current knowledge. Ann Thorac Surg 81:761–769\nAlifano M, Jablonski C, Kadiri H, Falcoz P, Gompel A, Camilleri-Broet S, Regnard JF (2007) Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med 176:1048–1053\nAlifano M, Roth T, Broët SC, Schussler O, Magdeleinat P, Regnard JF (2003) Catamenial pneumothorax: a prospective study. Chest 124:1004–1008\nRedwine DB (2002) Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril 77:288–296\nNezhat C, Seidman DS, Nezhat F, Nezhat C (1998) Laparoscopic surgical management of diaphragmatic endometriosis. Fertil Steril 69:1048–1055\nFukunaga M (1999) Catamenial pneumothorax caused by diaphragmatic stromal endometriosis. APMIS 107:685–688\nYamashita J, Iwasaki A, Kawahara K, Shirakusa T (1996) Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders. Surg Laparosc Endosc 6:485–488\nTayrac R, Gervaise A, Laurent D, Fernandez H (2001) Pneumothorax complicating laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 8:291–294\nJoseph J, Sahn SA (1996) Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 100:164–170\nAcknowledgments\nThis study was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) and the Megumi Medical Foundation of Kanazawa University.\nConflict of interest\nNone.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nKyo, S., Takakura, M., Nishida, S. et al. Massive hemothorax due to diaphragmatic endometriosis after a laparoscopic cystectomy of an ovarian endometrioma in a patient without a history of thoracic endometriosis. Arch Gynecol Obstet 286, 411–414 (2012). https://doi.org/10.1007/s00404-012-2313-7\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-012-2313-7","source_license":"CC0","license_restricted":false}