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Rationale:
Recurrent massive hemorrhagic ascites secondary to endometriosis is extremely rare in the medical literature.
Patient concerns:
We report the case of a 24-year-old nulliparous woman presenting with severe abdominal distention, massive ascites, moderate anemia, menstrual pain, and an elevated CA-125 level.
Diagnosis:
We found a thick...
Context in source publication
Context 1
... marrow smear and culture results had no abnormalities. Two hundred milliliters of dark brown fluid was drained out through paracentesis, and cytological analysis of ascites failed to find any evidence of malignant cells. An ultrasound scan of the abdomen and pelvis revealed massive ascites fluid with no evidence of intestinal and adnexal nodes (Fig. 1). An abdominal contrast computer tomography scan further disclosed extensive ascites. In addition, omental peritoneum ultrasonography, gastrointestinal endoscopy, echocardiography, and ultrasound scan of superficial lymph nodes were all normal. Because of no definite evidence, laparoscopy was recommended, but the patient rejected the ...
Citations
... To our knowledge, only two cases in the literature of massive hemoperitoneum due to endometriosis have been reported recently. 5,6 Because of its rarity, it is easy to misdiagnose, and clinicians need to pay attention to it. ...
Synopsis
This is a case of ascites secondary to endometriosis without atypical clinical symptoms, which is rare and prone to misdiagnosis.
... GnRH agonist treatment was used in 17 patients, GnRH antagonists in one patient, COC in three patients, LH agonist in one patient, dienogest in two patients, and medroxyprogesterone and norethindrone in one patient. There is a case that was treated with chemotherapeutic agents for suspected ovarian cancer [15] and two cases that were initially treated with antituberculous agents for suspected tuberculous ascites [24,38]. Therapy with fertilitypreserving management was decided in all but five patients at the initial management and included resection of all visible endometriotic nodules, adhesiolysis, and respective repairs of the affected organs such as colectomies and anastomosis, as shown in Table 2. ...
The presence of ascites is a common clinical presentation in gynecologic oncology patients. Hemorrhagic ascites (HA) due to endometriosis is a rare presentation that can be easily misdiagnosed as ovarian malignancies. The present study aims to update the currently available knowledge on the characteristics of patients presenting with HA due to endometriosis.
A systematic search was conducted for articles published from January 2000 to July 2020 using the Medline, Scopus, and Google Scholar databases along with the references of the full-text articles retrieved. Papers describing cases of women over 18 years with or without previous history of endometriosis were assessed. Only cases with histologically proven hemorrhagic ascites of endometriosis origin were included.
Twenty-nine studies (27 case reports and two case series) comprising 32 patients were evaluated. The mean patients’ age was 32 years, while six of the patients had a previous history of endometriosis. The mean amount of drained ascitic fluid was 4,200 mL, whereas three patients underwent thoracentesis due to pleural effusions. The treatment options included not only medical but also surgical therapies. Fertility preservation was achieved in 27 patients, while two of them achieved pregnancy with in vitro fertilization (IVF) techniques.
Endometriosis-related hemorrhagic ascites is a relatively rare expression of the disease. Endometriosis-related hemorrhagic ascites should be considered in the differential diagnosis (DD) of women with ascites and clinical suspicion of endometriosis. The available literature is limited to case reports and case series and thus indicates further research in the field to decode the pathophysiology of the disease and decide on the optimal treatment.
... 1,2 However, the appearance of hemorrhagic ascites as a symptom of endometriosis is an extremely rare entity in the existing literature. 3 The aim of the present study was to highlight the presence of hemorrhagic ascites as a symptom of existing endometriosis. ...
SynopsisThe contents of this page will be used as part of issue TOC only. It will not be published as part of main article.
Massive hemorrhagic ascites may be a symptom of peritoneal endometriosis.
... Cytological examination of endometriosis-related ascites shows hemosiderin-laden histiocytes instead of malignant cells (9). Core needle biopsy of thickened peritoneum has also been reported as a working method to confirm endometriosis (10). ...
Background:
Endometriosis is a disturbing condition affecting about 10% of all reproductive aged women. The most severe form of endometriosis is deeply infiltrative endometriosis (DIE). Bowel is commonly affected in DIE. Treatment options of bowel endometriosis include surgery and medication, depending on many factors such as age, the severity of symptoms and desire for pregnancy. At present, the individualized comprehensive management of bowel endometriosis is still under exploration. Here we report an uncommon case of bowel endometriosis treated by radical surgery and postoperative high-dose progestin to enrich the clinical experience.
Case description:
A 37-year-old woman was admitted to our hospital for suspected ovarian malignancy in the presence of pelvic mass, massive ascites and elevated CA-125. A laparoscopic radical surgery was performed, and she was diagnosed with bowel endometriosis. Considering the patient's high recurrence risk indicated by bowel endometriosis, massive ascites, severe adhesions, and dysmenorrhea, six-course gonadotropin-releasing hormone agonists therapy followed by high-dose progestin (two levonorgestrel intrauterine systems and subdermal implants) was administrated postoperatively to improve symptoms and prevent recurrence. No recurrence in bowels was observed by November 2021 (53 months).
Conclusions:
Both patient's desire and condition should be considered in the management of symptomatic bowel endometriosis. Optimal surgical removal is of great significance and individualized hormonal therapy may provide an additional component.
... In 1954, Brews reported the first case of endometriosis with ascites and in 2011, Gungor et al [3] published a systematic review analyzing 63 cases of endometriosis with ascites [3] . As of 2014, a total of 76 cases have been reported in the literature, and the majority of those cases were in nulliparous patients from Asia and Africa [4] . ...
Background:
Massive hemorrhagic ascites caused by endometriosis is exceedingly rare, and the treatment strategy remains controversial. Here, we report a case of endometriosis with massive hemorrhagic ascites treated with a novel triple therapy including conservative surgery, gonadotropin-releasing hormone agonist, and then dienogest.
Case summary:
A 28-year-old nulliparous patient was admitted to Shengjing Hospital of China Medical University, and exploratory laparoscopy was performed. A total of 9500 mL of brown ascites was aspirated from the pelvic cavity, the bilateral ovaries strongly adhered to the posterior of the uterus and were fixed to the pelvic floor, and endometriotic cysts were not observed in either ovary. The pelvic and abdominal peritonea were covered with patchy red, white, and brown endometriotic lesions and defects. Partial surgical resection of endometriotic lesions on the peritoneum was performed while we simultaneously collected multiple peritoneal biopsies. The final pathological diagnosis was endometriosis coupled with hemorrhagic necrotic tissue.
Conclusion:
Postoperative injection of gonadotropin-releasing hormone agonist was provided three times, followed by dienogest administration, and we will continue to follow up with this ongoing treatment.
Haemorrhagic ascites is primarily associated with perforated abdominal viscera, malignancies and tuberculosis or hepatic pathologies. However, its presentation due to ovarian endometriosis is a rare finding. We report the rare occurrence of haemorrhagic ascites due to ovarian endometriosis in a 26-year-old multiparous female presentingwith severe abdominal pain. The other probable causes of ascites were excluded and computed tomography of abdomen and pelvis revealed moderate ascites with bulky left ovarian cyst. Abdominal paracentesis revealed haemorrhagic ascitic fluid which on cytopathology did not reveal evidence of malignancy. Diagnostic work-up including magnetic resonance imaging and diagnostic laparoscopy confirmed the diagnosis. She was treated with oral dienogest which caused regression of the mass and pain. This case highlights that endometriosis may be included in the differential diagnosis while treating haemorrhagic ascites in women in reproductive age.
Background: Endometriosis mainly affects female pelvic tissues and organs, and the presence of endometriosis in the kidney is extremely rare.
Case Presentation: We report a case of a 48-year-old woman who presented with intermittent hematuria. She was found to have a cystic mass on renal ultrasonography, and contrast-enhanced computed tomography (CT) showed slight enhancement of the cystic wall and septa. These findings were indicative of cystic renal tumor. The patient subsequently underwent partial right nephrectomy. Histopathology revealed endometriosis of the right renal parenchyma. The patient recovered well and had no evidence of a recurrent renal mass at the 3 months' follow up.
Conclusion: The possibility of renal endometriosis should be considered in a female patient with a cystic renal mass and clinical symptoms related to the menstrual cycle.
Background: About 10% reproductive aged women are affected by endometriosis. Deep infiltrative endometriosis (DIE) is the most severe form of endometriosis which has a high risk of recurrence. Bowel is the most common extragenital involved organ. The clinical features of bowel endometriosis vary by location, size, and infiltrative depth of lesions, which makes diagnosis and treatment difficult. Endometriosis presenting with massive ascites is rare and hard to diagnose before histopathology. There are no authoritative guidelines on the management of DIE at present.
Case presentation: A 37-year-old woman presenting with massive ascites and pelvic mass was diagnosed with bowel endometriosis after laparoscopy. Bowel resection and anastomosis followed by gonadotropin-releasing hormone agonists (GnRH-a) therapy was performed. Two levonorgestrel-releasing intrauterine devices and two levonorgestrel-releasing subcutaneous silastic implants were inserted subsequently. Recurrence was found in bilateral ovaries 25 months after surgery. Cystectomy of bilateral ovarian cysts, bilateral salpingectomy and postoperative GnRH-a therapy was performed. The patient showed no recurrence at follow-up by May 2021 (22 months).
Conclusions: In the presence of massive ascites and pelvic mass, DIE should be considered as a differential diagnosis for ovarian cancer. Endometriosis in different organs may have different pathogenesis, which leads to different treatment focus. On the basis of complete resection and postoperative GnRH-a therapy, our application of high dose levonorgestrel-releasing systems creatively improves the treatment effect of bowel endometriosis. The mechanism of recurrent endometriosis that occurs in different organs may relate to lymph node involvement and individual immune state.
