We report the subsequent course of a previously-reported (Japanese abstract) case of catamenial pneumothorax (CPT) involving seven recurrences of pneumothorax during pregnancy, treated by thoracoscopic surgery and then small thoracotomy segmental resection and pleural covering with polyglycolic acid felt and fibrin glue. The patient took an oral contraceptive (OC) from 6 months postpartum until discontinuation after 2 years to become pregnant. Pregnancy occurred after 1 year and an elective caesarean section was performed in the 37th week of pregnancy. During that period, there was no evidence of recurrence of pneumothorax.
Endometriosis-related pneumothorax during pregnancy recurs with high probability following medical management by thoracic drainage. For pneumothorax during pregnancy occurring on the right side followed by early recurrence after medical management by thoracic drainage, endometriosis should be considered to be a possible cause, particularly when there is a past history of endometriosis. In such cases, we recommend early thoracoscopic surgery comprising not only resection of the endometriosis lesions after careful evaluation but also pleurodesis and/or covering with polyglycolic acid felt and fibrin glue. Further studies are needed to clarify and develop appropriate management of pneumothorax in pregnant women with a history of CPT.
Daisuke Katsura, Yoshihiko Hayashi, Takashi Hanatani, Tomoya Kono, Fuminori Kimura and Takashi Murakami