Katamenijalni pneumotoraks nakon višestrukih neuspešnih ciklusa vantelesne oplodnje
Sažetak
Uvod. Katamenijalni pneumotoraks je spontani pneumotoraks nastao u periodu od 72–96 h pre ili nakon menstrualnog krvarenja. Često je povezan sa torakalnom endometriozom. Međutim, u pojedinim slučajevima nije identifikovana torakalna patologija. Prikaz bolesnika. Bolesnica, stara 42 godine, sa prethodnom pelvičnom endometriozom javila se zbog naglog kašlja i osećaja nedostatka vazduha prvog dana menstrualnog ciklusa. Rendgenski snimak grudnog koša prikazao je kompletni desnostrani pneumotoraks. Pre ovog događaja, bolesnica je prošla 7 neuspešnih ciklusa vantelesne oplodnje. Video-asistirana torakoskopija pokazala je bulozne lezije pluća i fenestraciju dijafragme. Učinjena je atipična resekcija plućnog vrha endostaplerom, kao i plikacija dijafragme Ethibond šavovima. Definitivni histopatološki pregled tkiva nije dokazao endometriozu. Postoperativno, u toku 6 meseci, bio je primenjen triptorelin, agonist gonadotropin-releasing (oslobađajućeg) hormona (GnRH). Postoperativni tok je bio uredan, bez recidiva pneumotoraksa. Zaključak. Postoji mogućnost da je ovarijalna hiperstimulacija izazvala rupturu plućnih bula. Takođe, moguće je da je bolesnica imala endometriozne fenestracije dijafragme aktivirane ovarijalnom hiperstimulacijom, što je dovelo do pneumotoraksa. Rana dijagnoza i pravovremeni hirurški tretman, kao i adjuvantna hormonska terapija, mogu smanjiti stopu recidiva katamenijalnog pneumotoraksa.
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