Endometriosis-associated pneumothorax: “uncommon” disease

Introduction: We are presenting the largest Russian single-centre experience in the treatment of endometriosis-associated pneumothorax (EAP). Methods: Retrospective analysis of 182 women of reproductive age with spontaneous pneumothorax who underwent visual examination of the pleural cavity since 2004 till 2018. Patients divided into two groups: 33 women in EAP-group, and 149 women – control group. The assortment criteria for EAP-group were diaphragmatic or pleural endometrial implants and/or diaphragmatic fenestrations. Results: Mean age was 40.5±7.1 in the EAP-group vs. 31.8±9.1 yrs in the control group. Right sided localization found in 93,9% in EAP-group, vs 64,4% in control-group. Recurrent pneumothoraces were seen in 70% of cases in EAP-group, and in 26,9% in control group. Concomitance with menses seen in 63,6% of women in the EAP group and in 36,6% of women in the control group. Specific findings in EAP group were: diaphragmatic fenestrations in 39,3%, pleural implants in 14,3%, implants and fenestrations in 46,4% of cases. Complications rate was 29% in EAP-group and only 12,7% in the control group. Postoperative recurrence was seen in 32,3% in EAP-group, and 7,4% in the control group. Most effective operative treatment for EAP was diaphragmatic resection, reinforcement of the suture line with a polypropylene mesh and hormonal treatment with GNRH-agonists or combined oral contraceptives under supervision of the gynecologist for 3-6 months. Conclusion: EAP can be seen in up to 34% of women in reproductive age with recurrent spontaneous pneumothorax. Diaphragmatic fenestrations are specific sign of EAP. Surgical treatment of EAP is more comlicated and less efficient. Postoperative treatment of endometriosis is inevitable.