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Published on: April 19, 2022
[Catamenial hemothorax: Results of 11 operated cases]
R Ouede1, Z Kone2, L L Kohou-Kone3
1Service de chirurgie thoracique, institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire.
Insights
This study details a surgical approach for catamenial hemothorax, involving diaphragmatic repair and hormone therapy. The treatment showed low recurrence, suggesting effectiveness for this rare condition.
Area of Science:
- Thoracic Surgery
- Gynecologic Surgery
- Pulmonology
Background:
- Catamenial hemothorax is a rare condition characterized by recurrent spontaneous hemothorax synchronized with menstruation.
- Diaphragmatic fenestrations are often implicated in the pathophysiology of catamenial hemothorax.
Purpose of the Study:
- To describe a therapeutic strategy for managing catamenial hemothorax.
- To evaluate the efficacy of surgical repair combined with hormonal therapy.
Main Methods:
- Retrospective analysis of 11 patients treated for catamenial hemothorax between 1994 and 2018.
- Surgical intervention included posterolateral thoracotomy with diaphragmatic fenestration repair (resection or synthetic patching) and pleural symphysis.
- Systematic 6-month postoperative hormone therapy with triptorelin was administered.
Main Results:
- Zero mortality was observed.
- The mean postoperative hospital stay was 10.24 days, with a mean follow-up of 3.5 years.
- One recurrence of hemothorax occurred after hormone therapy cessation; five cases of associated ascites recurred.
Conclusions:
- Phrenoplasty with synthetic patches, pleural talcage, and 6-month hormone therapy is recommended for catamenial hemothorax with diaphragmatic fenestrations.
- This approach demonstrates a low recurrence rate for hemothorax.
- Associated hemorrhagic ascites may require separate gynecological management.
Objective:
To report our therapeutic approach toward catamenial hemothorax.
Patients And Methods:
This retrospective study from January 1994 to November 2018 concerned patients operated under general anesthesia for catamenial hemothorax. A posterolateral thoracotomy approach was implemented either directly or after primary videothoracoscopy. Six-month hormone therapy was systematically prescribed postoperatively. The result was assessed in terms of occurrence or non-occurrence of hemothorax upon resumption of menses after discontinuation of hormone therapy.
Results:
Eleven patients were selected, with an average age was 32years (25-41). Catamenial hemothorax was associated with hemorrhagic ascites in 5 cases. Endometriotic plaques in the form of diaphragmatic fenestrations were found nine times and were resected (1 case) or covered by a synthetic non-absorbable patch (8 cases). Pleural symphysis completed the surgical procedures. The one hormone used was triptorelin. Mortality was zero. Mean postoperative hospital stay was 10.24days and mean follow-up was 3.5years. One patient was lost to follow-up at 3months. One hemothorax recurrence was observed after discontinuation of hormone therapy at 4months [1], and repeated pleural punctures were carried out while awaiting revision surgery. The five cases of ascites recurred and the patients were monitored in the gynecology unit.
Conclusion:
In patients suffering from catamenial hemothorax with diaphragmatic fenestrations, we recommend phrenoplasty using synthetic patches associated with pleural talcage and 6-month complementary concomitant hormone therapy.
