Two Cases of Endometriosis Presenting with Catamenial Pneumothorax and Umbilical Lesions

Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 607 Two Cases of Endometriosis Presenting with Catamenial Pneumothorax and Umbilical Lesions McDonough AL, Zeisler J. Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, Connecticut Patients: Two cases of catamenial pneumothorax and associated endometriotic lesions of the umbilicus presented to the same general gynecology practice within two years. The first case was a 30-year-old nulliparous female referred to the gynecologist for evaluation and management of endometriosis with recurrent pneumothorax, status post wedge resection of the right lung. The patient complained of cyclical umbilical pain, which worsened with menses. She underwent a resection of the umbilical endometrioma and diagnostic laparoscopy, which revealed extensive pelvic endometriosis. Postoperatively she was started on Lupron with good improvement of symptoms. The patient has been offered definitive therapy with hysterectomy and bilateral salpingooophorectomy once she no longer desires fertility preservation. The second case is a 28-year-old nulliparous female referred to the gynecologist by her cardiothoracic surgeon’ for a chief complaint of chest pain associated with her menses for the past four years. The patient had experienced two pneumothoraces over the prior 6 months, status post lysis of apical adhesions and pleurodesis. About three months after she initially presented to the gynecologist she began complaining of pain in her umbilicus. On examination she had a 1-2cm nodular area in the umbilicus, which on ultrasound showed a complex fluid accumulation. She underwent an umbilical mass excision and diagnostic laparoscopy with excisional biopsy of a left ovarian mass. Conclusion: Literature review resulted in two case reports of prior catamenial pneumothorax with associated umbilical lesions. Umbilical lesions are a particularly rare manifestation of endometriosis in patients without prior surgery. Based on the limited literature available hysterectomy with bilateral salpingo-oopherectomy should be offered as definitive therapy in these patients once they no longer desire preservation of fertility.

608 Complications During Pregnancy in Patients With Deep Infiltrating Endometriosis (DIE) Exacoustos C,1 Lauriola I,2 De Felice G,3 Frusca T,2 Zupi E.3 1 Department of Obstetrics and Gynecology, Universita degli studi di Roma ‘Tor Vergata,’ Roma, Italy; 2Department of Obstetrics and Gynecology, Universit a degli Studi di Parma, Parma, Italy; 3Dipartimento Di Medicina Molecolare E Dello Sviluppo, Universita degli Studi di Siena, Siena, Italy Study Objective: to analyze the outcome and complications during pregnancy and delivery in patients with deep endometriosis diagnosed at laparoscopy and at ultrasound examination prior to pregnancy.

S169

Design: Retrospective study with follow up interviews. Setting: University hospitals. Patients: the criteria of inclusion patients with posterior DIE; less than 40 years age; desiring pregnancy. All the included patients showed on Transvaginal scan (TVS) DIE nodule of more than 2 cm. Endometriosis was confirmed on laparoscopy and histology. Intervention: Pregnancy outcome and complications of all included patients were collected from medical charts and by phone interviews. Measurements and Main Results: Out of 101 patients included in this study, 52 obtained a pregnant. We observed 13 cases of spontaneous abortion in the first trimester and 41 cases of term and preterm pregnancies. Of the 52 patient, 18 patients conceived by ART (assisted reproductive therapy). During the pregnancy 7 patients were hospitalized for abdominal pain, 6 had a placenta previa, 13 delivered before 37 weeks. Observed complication at delivery during C-section were: 2 hysterectomies, 1 bowel resection, 2 bladder lesions, 4 extended adhesiolysis with 2 salpingectomies. Following a vaginal delivery, 1 vaginal laceration that caused a severe post-partum hemorrhage. Conclusion: Patients with posterior DIE show a high infertility and complications rate during pregnancy and delivery. These complications were often not correlated to DIE and probably under-reported. This study suggests that pregnancy does not improve DIE condition. This suggests that the endocrine environment of pregnancy does not prevent activation of the disease.

609 Size of Rectosigmoid Endometriotic Nodule and Dyschezia: What’s the Novelty? Di Donato N, Costantino C, Montanari G, Facchini C, Zanello M, Seracchioli R. Minimally Invasive Gynaecological Surgery Unit, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy Study Objective: Purpose of this study was to evaluate the relationship between the severity of dyschezia with size of endometriotic rectosigmoid lesion. Design: Retrospective analysis of 82 patients with rectosigmoid endometriosis. Setting: Tertiary care university hospital. Patients: Patients with rectosigmoid endometriosis were grouped by preoperative severe dyschezia (VAS R8) and intra-operative diameter and volume of rectosigmoid endometriotic nodule were assessed. Other symptoms (dysmenorrhea, dyspareunia, dysuria and chronic pelvic pain) and presence of ovarian endometriosis, medical therapy and history of previous surgery for endometriosis were also recorded. Intervention: Laparoscopic intestinal shaving, preoperative scoring of dyschezia using 10-point verbal analog scale (VAS). Measurements and Main Results: Patients with severe dyschezia presented significantly smaller rectosigmoid nodule in size than those without dyschezia (mean major diameter 24.65.57 versus 34.1210.53 and mean volume 11.51.85 versus 14.713.51) (p\0.0001). Moreover, mean lesion diameter and volume in patients with severe dyspareunia (VASR8) was 26.67.97 and 12.22.65 mm versus 32.010.4 and 14.03.48 mm in patients without severe dyspareunia (p:0.04). There was a negative Spearman rank correlation between lesion major diameter and severity of dyschezia (Rho: -.259; p: .009). Conclusion: Severe dyschezia was significantly associated with smaller rectosigmoid endometriotic nodule. There was a negative correlation between severity of dyschezia and lesion diameter and volume.

610 Increased Expression Levels of Metalloprotease, Tissue Inhibitor of Metalloprotease, Metallothionein, and p63 in Ectopic Endometrium Rosa-e-Silva JC, Brandao VC, Meola J, Troncon JK, Poli-Neto OB. Gynecology and Obstetrics, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil