A young woman with abdominal distension

Abstract

SUMMARYWe present the case of a 34-year-old woman with haemorrhagic ascites and an extrinsic rectal mass on endoscopy. Endometrioma was subsequently confirmed by laparoscopy and biopsy. Intestinal endometriosis is common, and often mimics other gastrointestinal pathology. Haemorrhagic ascites or intestinal masses are rare presentations of endometriosis, and this is the only reported case of both occurring together. Endometriosis and ascites are more common in women of African descent, and although histological diagnosis requires laparoscopy, MRI has a high negative predictive value; 95% for intestinal endometriosis. Re-accumulation of ascites were prevented by starting a gonadotrophin antagonist. BACKGROUND

Ascites and Encapsulating Peritonitis in Endometriosis: a Systematic Review with a Case Report

“…A total of 8 women in the included articles were described as “black”; 3, as “African-American”; and 2, as “Afro-Caribbean.” 12 13 15 16 17 18 19 20 21 22 One patient described herself as “African;” another patient, as “caucasian;” a third one, as “Hispanic;” and another one, as “negro.” 23 24 25 26 Seven studies did not describe ethnicity, but reported that the patients were Nigerian ( n = 3), Malay ( n = 2), Brazilian ( n = 1) or Japanese ( n = 1). 3 6 8 27 28 29 30 Ethnicity or origin was not described at all for the remaining 16 patients. 5 7 11 14 31 32 33 34 35 36 37 38 39 40 41 42 …”

“… 22 24 However, in 15 articles (describing 17 patients), the presence or absence of dysmenorrhea was not mentioned at all. 5 6 7 12 14 19 21 25 26 28 29 33 34 35 37 A total of 33 studies (with 38 patients) were regarding the presence or absence of dyspareunia, 3 5 6 7 8 11 12 13 14 16 17 18 19 20 21 25 26 27 28 29 30 31 32 33 34 35 37 38 39 40 41 42 and 25 studies (with 28 patients) were regarding the presence or absence of infertility. 3 5 6 7 8 11 12 13 14 15 16 17 21 25 26 27 28 32 33 34 35 …”

“…[23][24][25][26] Seven studies did not describe ethnicity, but reported that the patients were Nigerian (n ¼ 3), Malay (n ¼ 2), Brazilian (n ¼ 1) or Japanese (n ¼ 1). 3,6,8,[27][28][29][30] Ethnicity or origin was not described at all for the remaining 16 patients. 5,7,11,14,[31][32][33][34][35][36][37][38][39][40][41][42] Records identified through a database search (n = 234)…”

“…3,[5][6][7][8][11][12][13][14][15][16][17]21,[25][26][27][28][32][33][34][35][36][37][38][39] Fifteen articles did not mention if any of these three symptoms were present or absent in the cases they reported. [5][6][7]12,14,21,25,26,28,[33][34][35]37 Besides our patient, only five cases of encapsulating peritonitis due to endometriosis have been described in the medical literature. 3,[5][6][7][8]…”

Endometriosis associated with relapsing ascites and pleural effusions

“…Since its original description, there are 60 patients reported in the literature (Gungor et al 2011;Ferrero and Remorgida 2011;Appleby et al 2014). Treatment options in this challenging scenario include surgical intervention and/or hormonotherapy, including danazol, oral contraceptives, GnRH analogues and progestational agents (Muneyyirci-Delale et al 1998).…”