Intrathoracic endometriosis with hemopneumothorax after laparoscopic cholecystectomy: A case report

症例報告 腹腔鏡下胆嚢摘出術後に血胸をきたした胸腔内子宮内膜症の１例 2021 年 37 巻 1 号 p. 194-198 詳細 抄録 Intrathoracic endometriosis is a rare and atypical site of endometriosis. A large number of cases of intrathoracic endometriosis are being reported in recent times, owing to an increase in the incidence of endometriosis. We report a case of hemopneumothorax secondary to intrathoracic endometriosis, following laparoscopic surgery. A 49-year-old woman who underwent laparoscopic cholecystectomy for gallstones at another hospital developed significant right-sided pleural effusion, along with right-sided pulmonary collapse and pneumothorax on postoperative day 3, and hemopneumothorax was suspected in this case. We performed thoracoscopic surgery to confirm the diagnosis. Intraoperatively, we observed no clear evidence of intrathoracic bullae; however, we detected several small brittle ruptured pleural vessels and hemorrhage from these vessels. Furthermore, we observed endometrial deposits in the diaphragm, and a biopsy of the resected tissue confirmed diaphragmatic endometriosis. We speculated that the gas used to establish pneumoperitoneum passed through the diaphragmatic defect caused by intrathoracic endometriosis, leading to pneumothorax, which resulted in rupture of the brittle intrathoracic vessels and consequent hemopneumothorax. Hemopneumothorax following laparoscopic surgery is rare. However, intrathoracic endometriosis increases the risk of hemopneumothorax, as observed in our patient. Prediction of intrathoracic endometriosis prior to its development is challenging. © 2021 日本産科婦人科内視鏡学会