Abstract
Background: Endometriosis associated with massive haemorrhagic ascites is an exceedingly uncommon finding. In most of the cases, the presence of massive hemorrhagic ascites is associated with malignancies, hepatoma, tuberculosis or perforated viscous. This case report draws attention to this condition of massive hemorrhagic ascites as a complication of endometriosis. Case: A 25-year-old, nulligravida with massive haemorrhagic ascites and right adnexal mass in CT scan underwent laparotomy, and peroperatively three liters of hemoperitoneum was found with no signs of malignancy on examination of ovary. The histological report of abdominal peritoneum was compatible with an endometriosis. The patient was treated with a GnRH analogue in postoperative period with progressive reduction of ascitic fluid. Patient is on follow up. Conclusion: Haemorrhagic ascites should be considered as a complication of endometriosis, especially in nulliparous women of childbearing age group with abdominal distention, dysmenorrhea, abdominal pain and haemorrhagic ascites, suggesting a diagnosis of ovarian malignancy.
Highlights
Endometriosis associated with massive haemorrhagic ascites is an exceedingly uncommon finding
Endometriosis presenting as a recurrent haemorrhagic ascites is an unusual occurrence, more than 60 cases have been reported since 1954 [3,4], and these patients are usually noncritical with minimal significant complications [5,6]
Hemorrhagic ascites should be considered a complication of endometriosis, especially in nulliparous women of childbearing age group with an abdominal distention, a pelvic mass, dysmenorrhea, abdominal pain, weight loss and eventual pleural effusion, suggesting a diagnosis of ovarian malignancy [9]
Summary
Twenty-six-year-old nulliparous female attended gynaecology OPD with the chief complaints of abdominal distension since three months associated with the lower abdominal pain. Bowel movements were normal and there was no history of nausea, vomiting, hematemesis and melena. She had no history of coagulation disorders and platelet dysfunction She was admitted in some private hospital before she reported here, there she has received one unit blood and underwent extensive evaluation for abdominal distension. Her menarche was at 13 years of age She had a regular normal flow with no history of dysmennorhoea or dyspareunia. She is a nulliparous female married for 1 year. Massive ascites was present with low level internal echoes, uterus was normal size, and in right adnexa 5.2 × 5.3 cm cystic lesion with mixed septations and peripheral vascularity was present and right ovary was not seen separately. Omental biopsy showed fibroadipose tissues with focal mild chronic inflammation, right ovarian biopsy showed ovarian tissue with evidence of endometriosis (Figure 1) and peritoneal biopsy showed fibrovascular tissues with areas of haemorrhage and findings suggestive of endometriosis (Figure 2)
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