Concomitant umbilical endometriosis with catamenial pneumothorax: a case report

Abstract

Catamenial pneumothorax is an extremely rare conditions that affects women and is one of a group of diseases called extra-pelvic endometriosis. Moreover, when concomitant of extra-pelvic endometriosis occurs in the same patient is rarer to be found. A 35-year-old female presented with a 3-month history of bleeding from the umbilicus during her menstrual cycles. Right pneumothorax was incidentally detected on her abdominal X-ray already taken in primary care, and chest and abdominal computed tomography showed a 2.5-cm enhancing mass below umbilicus. As a result, the patient was diagnosed as concomitant Catamenial pneumothorax with umbilical endometriosis. Thus, she underwent video-assisted thoracoscopic surgery (VATS), diaphragmatic resection and repair using a polypropylene mesh and umbilical mass excision. Pathological analysis of the collected specimens revealed both umbilical and diaphragmatic endometriosis. Hence, she was treated with a gonadotropin-releasing hormone agonist to prevent disease recurrence. During a 6-month follow-up, she displayed no sign of umbilical bleeding or pneumothorax. This case report demonstrates the concurrent manifestation of catamenial pneumothorax and umbilical endometriosis as part of extra-pelvic endometriosis and does support the retrograde menstruation theory as the etiology of extra-pelvic endometriosis.

Keywords: Catamenial pneumothorax; case report; endometriosis; video-assisted thoracoscopic surgery (VATS).

Figure 1

Bleeding at umbilicus during patient menstrual cycle.

Figure 2

Timeline. VATS, video-assisted thoracoscopic surgery.

Figure 3

Her chest X-ray revealed right pneumothorax.

Figure 4

Abdominal computed tomography shown enhancing lesion at abdominal wall.

Figure 5

Diaphragm fenestration was found during video assisted thoracoscopic surgery.