992 Peri-Operative Consideration in Peri-Partum Management of Primary Spontaneous Pneumothorax Secondary to Thoracic Endometriosis: A Case Report and Review of the Literature

Abstract Aim We present a case of a patient with a new diagnosis of pneumothorax in the peripartum period and the role of MDT in ensuring an optimal outcome. Method 31 year-old post-partum female presented with a right-sided unresolving pneumothorax on the background of laparoscopically-confirmed endometriosis. Her pneumothorax was initially diagnosed at 35 weeks of pregnancy and was her first episode. She had no symptoms associated with menstrual cycle. Her past medical history only included gastric ulcers otherwise. Her pneumothorax was initially managed with a chest drain until delivery by uncomplicated C-Section. However, her lung remained not re-expanding despite trial od suction. Diagnostic workup included CT, diagnostic laparoscopy, VATS assessment and biopsy. Results VATS demonstrated obvious macroscopic endometrial diaphragmatic deposits which were biopsied alongside the visceral pleura. Right bullectomy and talc pleurodesis were also performed. Complete resolution of the pneumothorax on post-operative imaging was demonstrated. Patient was seen in gynaecology clinic on discharge and started on Relugolix in the interest of decreasing her subsequent risk of spontaneous pneumothorax. Conclusions This case reinforces the need for a high index of suspicion for thoracic endometriosis when evaluating women of child-bearing age who present with recurrent or persistent pneumothorax. This is particularly important when symptoms arise in the postpartum period or display any temporal relationship to hormonal changes. It highlights the importance of coordinated multidisciplinary involvement involving thoracic surgery, gynaecology, and respiratory medicine at an early stage. Early discussions can significantly enhance diagnostic accuracy ensuring that both operative and postoperative plans are tailored to the patient’s specific needs.