Ectopic endometrial tissue in a diaphragmatic fistula; A case report of pleuroperitoneal communication treated with thoracoscopic surgery

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  • Kaneda Shinji
    Department of Thoracic and Cardiovascular Surgery, Mie University Hospital
  • Tochii Sachiko
    Department of Thoracic Surgery, Fujita Health University Okazaki Medical Center
  • Kawai Hiroshi
    Department of Thoracic Surgery, Fujita Health University School of Medicine
  • Tochii Daisuke
    Department of Thoracic Surgery, Fujita Health University Okazaki Medical Center
  • Suda Takashi
    Department of Thoracic Surgery, Fujita Health University Okazaki Medical Center
  • Hoshikawa Yasushi
    Department of Thoracic Surgery, Fujita Health University School of Medicine

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  • 横隔膜小孔に異所性子宮内膜組織を認めた横隔膜交通症の1手術例

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Abstract

<p>Introduction: Pleuroperitoneal communication is a serious complication of continuous peritoneal dialysis (CAPD). We report a patient undergoing CAPD who developed pleuroperitoneal communication that was successfully treated via thoracoscopic partial resection of the diaphragm, including a transmural fistula containing ectopic endometrial tissue.</p><p>Case: A 42-year-old woman who developed right pleural effusion after CAPD started treatment for endstage renal failure due to endocapillary proliferative glomerulonephritis. Pleural effusion testing revealed a high glucose concentration, and contrast medium injected into the peritoneal cavity entered the right thoracic cavity; therefore, pleuroperitoneal communication was diagnosed. Thoracoscopic surgery was performed under general anesthesia with differential lung ventilation. When peritoneal dialysate mixed with 10 mL of indigo carmine was injected into the peritoneal cavity, leakage of blue liquid was observed from a brown fistula near the central tendon of the right diaphragm. The right diaphragm (including fistula) was partially resected using an automatic suturing device, and the resected end was reinforced with knotted sutures and wide coverage with a polyglycolic acid sheet. Pathological examination revealed ectopic endometrial tissue in the diaphragmatic fistula. Peritoneal dialysis was resumed on postoperative day 7, and hormone therapy was administered to prevent recurrence of the diaphragmatic fistula owing to ectopic endometriosis. There has been no recurrence in 1.5 years of follow-up.</p><p>Conclusion: Thoracoscopic surgery is useful for identifying and treating the site of pleuroperitoneal communication. Ectopic endometriosis may contribute to the development of pleuroperitoneal communication. Histopathological examination should be done to confirm the diagnosis and guide further treatment to prevent recurrence.</p>

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