Multidisciplinary Treatment for Thoracic and Abdominopelvic Endometriosis

Abstract

Background and Objectives:Thoracic endometriosis is a rare form of extragenital endometriosis with important clinical ramifications. Up to 80% of women with thoracic endometriosis have concomitant abdominopelvic endometriosis, yet the surgical treatment is usually performed with separate procedures. This is the largest published series of the combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic and thoracic endometriosis. The objectives of this series are to further evaluate the manifestations of thoracic endometriosis, assess the multidisciplinary surgical approach, and discuss our institution's protocols.Methods:This is a retrospective, institutional review board–approved case series of 25 consecutive women who underwent combined video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of abdominopelvic, diaphragmatic, and thoracic endometriosis from January 1, 2008, to September 30, 2013. All surgeries were performed at a tertiary referral center by the same primary surgeons. Data were collected by chart review.Results:Twenty-five patients were included, with a mean age of 37.7 years. Eighty percent of patients had catamenial chest pain, and in 40% this was their only chest complaint. Shoulder pain was noted in 40% of patients, catamenial pneumothorax in 24%, and hemoptysis in 12%. One hundred percent of patients were found to have endometriosis in the pelvis, 100% in the diaphragm, 64% in the chest wall, and 40% in the parenchyma. There were 2 major postoperative complications: 1 diaphragmatic hernia and 1 vaginal cuff hematoma.Conclusion:Clinical suspicion and preoperative assessment are crucial in the diagnosis of thoracic endometriosis and allow for a multidisciplinary approach. The combination of video-assisted thoracoscopic surgery and traditional laparoscopy for the treatment of endometriosis optimally addresses the pelvis, diaphragm, and thoracic cavity in a single operation.

Thoracic endometriosis syndrome at University of Ilorin Teaching Hospital

“…The mean age of occurrence of TES in our patients was 28.7 years (SD 8.63); this is younger than the ~35 years reported in the literature. [2][3][4]8,10,13,21] The presentation of CHp in one of our youngest patients (19 years) may support the postulate that this manifests at a relatively younger age than other forms of manifestation. [4] An interesting finding from this study is the predominance of CPE, accounting for 75% of cases, while CCP was second, with 37.5%.…”

“…The 87.5% predominance on the right side in this study is consistent with previous reports of the vast majority of TES (above 85%) occurring in the right hemithorax. [2,3,5,6,10,13,21] This predilection has been attributed to clockwise peritoneal circulation by some authors. [5] Multisite involvement in extragenital endometriosis is rare.…”

Catamenial pneumothorax: Presentation of an uncommon Pathology

“…Therefore, we emphasize that the importance of multidisciplinary management among the gynecologist, urologist, proctologist and general and thoracic surgeon has also demonstrated the depreciation in the recurrence rates of Disease, showing better postoperative results [11]. In summary, according to the literature found and our experience, the ideal management of thoracic endometriosis is apicectomy, placement of prosthetic material in the affected areas within the thorax and hormone therapy [12,[14][15][16][17].…”

Thoracic endometriosis, a review

“…Catamenial hemoptysis occurs in less than 14 percent of patients and is typically due to parenchymal or endobronchial endometriosis. 3,16 The mean age of patients presenting with hemoptysis (26 to 29 years) appears to be lower than patients with other manifestations of thoracic endometriosis (34 years). 3,17 Bleeding is usually catamenial, minor, and right-sided.…”