Massive Hemorrhagic Ascites Secondary to Endometriosis

T, El Khalil; Mourad, FH; Barada, Kassem; Uthman, S

doi:10.1097/00004836-199912000-00010

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Repeated haemoglobin measurements, vaginal ultrasound, CT-scan or optionally a culdocentesis can help to make this distinction. This enables us to make a first step in the differential diagnosis - ascites originates from carcinomatous peritonitis, liver cirrhosis, portal vein thrombosis or heart failure ( El Khalil et al 1999 ); free blood can be the consequence of a ruptured ectopic pregnancy, ruptured ovarian cysts i.a. endometriomas, a corpus luteum or other non-gynaecological pathology.…”

Section: Discussionmentioning

confidence: 99%

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

Vandenameele¹,

Alaerts²

2021

Facts Views Vis ObGyn

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Objective: We report 2 cases of haemoperitoneum due to a bleeding of the uterine artery caused by infiltrating endometriosis. We have also conducted a literature review on endometriosis-related intra-abdominal haemorrhage and wrote a practical guideline on how this entity can be recognized and handled. Patients: Case 1: A 49-year-old multiparous woman presented with intense stabbing pain in the lower abdomen during her menstruation. CT angiography showed a bleeding from a side branch of the internal iliac artery. Laparoscopy was performed and an active bleeding from the right uterine artery was confirmed, clearly caused by infiltrating endometriosis lesions. Haemostasis was achieved by bipolar coagulation. Case 2: A 29-year-old nulliparous woman was admitted for observation because of heavy stabbing pain in the right lower quadrant and presence of free fluid on CT abdomen. The day after the admission, laparoscopy was performed because of a decreasing haemoglobin level. An arterial bleeding from the right parametrium was observed, probably originating from the right uterine artery. Histopathological examination of a biopsy of the right parametrium proved the presence of endometriosis. Haemostasis was achieved by bipolar coagulation. Conclusion: Although endometriosis-related haemoperitoneum is a rare entity, this diagnosis should be considered when a patient presents with an intra-abdominal haemorrhage during menstruation or withdrawal bleeding - especially in case of a history or suspicion of endometriosis. Laparoscopy is the cornerstone of the treatment.

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Section: Discussionmentioning

confidence: 99%

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

Vandenameele¹,

Alaerts²

2021

Facts Views Vis ObGyn

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“…The pathophysiology of endometriosis associated with massive bloody ascites is uncertain. 5 The idea that peritoneal irritation from ruptured endometriotic cysts is supported by the fact that the ascites associated with endometriosis is of an exudative nature. 6 In addition, adhesions may result in the blockage of lymphatic vessels leading to accumulation of fluid.…”

Section: Discussionmentioning

confidence: 99%

“…There have been no case reports of recurrence following surgical obliteration of ovarian function. 5 It is difficult to evaluate the efficacy of surgical excision of endometriosis alone as endocrine therapy is most often given in conjunction. In our case, the patient was considered too unwell for elective surgical excision of endometriosis and thus was commenced on hormone suppression with goserelin.…”

Section: Discussionmentioning

confidence: 99%

Benign endometriosis masquerading as intra-abdominal malignancy: One of the most extreme cases reported and a review of the literature

Walker

Johnson

2018

Journal of Endometriosis and Pelvic Pain Disorders

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Introduction: To elicit key clinical lessons from an extreme case of endometriosis associated with massive ascites and a review of the literature. Methods: We report one of the most extreme cases of massive ascites caused by endometriosis. For literature review, MEDLINE via OVID (from 1946 to 2016) database was searched. As a result, all the publications based on the keywords relating to the review topic were acquired. Case: A 32-year-old nulliparous woman, with stage 4 endometriosis and primary infertility, presented with massive ascites, complex pelvic mass, pleural effusion, weight loss, anaemia and elevated CA-125 suggesting ovarian malignancy. Six litres of ascites was drained. After extensive investigations to exclude malignancy, endometriosis-related ascites was diagnosed. Red-cell transfusion, nasogastric-tube-feeding and gonadotrophin-releasing-hormone analogue were initiated and longterm follow-up is planned. Ablation of ovarian function either by surgical oophorectomy or ovarian irradiation appears to cure the condition without recurrence. Endocrine therapy, in the form of gonadotrophin-releasing-hormone analogue or progestins, is useful if surgery is undesirable, as most women with this condition are young and wish to preserve fertility. Endocrine therapy alone resolves the problem in the majority, but ascites reappears after stopping treatment. Conclusion: Endometriosis associated with massive ascites and pleural effusion is rare. There are less than 30 similar case reports in the literature. In women of reproductive age who present with clinical and imaging features to suggest ovarian malignancy, a diagnosis of endometriosis should be considered. Although permanent cure is by oophorectomy, endocrine therapy is useful if surgery is undesirable.

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“…Less frequently, the rectovaginal septum, appendix and small intestine, in particular the terminal ileum, probably because of its proximity to tubes and ovaries, are involved [13]. Moreover, though very rarely, clinical patterns apparently not related to endometriosis, such as pleural or pericardial effusion, pneumothorax, hemothorax, headache and seizures, may present because of locations of endometrial tissue in other sites than the abdominal and pelvic ones [2,3,[14][15][16]. In particular, pain or dyspnea associated with a pneumothorax (usually right) in case of pleural involvement, and haemoptysis in lung parenchymal localizations have been described [17].…”

Section: Introductionmentioning

confidence: 99%

Endometriosis, need for a multidisciplinary clinical setting: the internist’s point of view

et al. 2010

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Endometriosis is a common condition characterized by proliferation of endometrial tissue outside the uterus, both in the pelvis and in other extra-pelvic sites. The clinical picture of endometriosis is widely heterogeneous. A correct diagnostic work-up of these patients can sometimes be very difficult, since there are a number of gynecological, intestinal and systemic diseases mimicking endometriosis, as well as other conditions that could be associated with or are a consequence of this disorder. Therefore, multidisciplinary care should be encouraged to ensure correct evaluation and improve the management of these patients.

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Massive Hemorrhagic Ascites Secondary to Endometriosis

Cited by 9 publications

References 4 publications

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

Acute haemoperitoneum caused by endometriosis infiltrating the uterine artery - Two case reports and a literature review

Benign endometriosis masquerading as intra-abdominal malignancy: One of the most extreme cases reported and a review of the literature

Endometriosis, need for a multidisciplinary clinical setting: the internist’s point of view

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