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

Magalhães, Thaís Fontes de; Augusto, Kathiane Lustosa; Mota, Livia Ponte; Costa, Arthur Ribeiro da; Puster, Rainardo Antônio; Bezerra, Leonardo Robson Pinheiro Sobreira

doi:10.1055/s-0038-1626700

Cited by 9 publications

(15 citation statements)

References 42 publications

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“…When a woman presents with ascites, exclusion of certain gynecological disorders, including ovarian cancer, primary peritoneal cancer, fallopian tube cancer, and pelvic tuberculosis, is necessary. Ascites secondary to endometriosis is a rare phenomenon, of which the first case was reported in 1954 [11] and only approximately 60 cases have been reported worldwide [6,12]. The clinical presentation in our patient is generally consistent with those that have previously been reported, except with regard to the patient's parity status and ethnicity.…”

Section: Discussionsupporting

confidence: 83%

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Endometriosis-Associated Massive Ascites in an Asian Woman: A Case Report of a Rare Clinical Entity

Eamudomkarn

Likitdee

Kleebkaow

et al. 2020

Case Reports in Obstetrics and Gynecology

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Massive ascites as a presentation of endometriosis is a rare clinical entity that is most commonly seen in black nulliparous females. Herein, we describe a case of a 32-year-old multiparous Thai woman who presented with a two-year history of abdominal distension. Computerized tomography of the abdominopelvic region showed an infiltrative enhancing lesion involving the cul-de-sac and perirectal region with massive loculated ascites, suggesting carcinomatosis peritonei. Abdominal paracentesis was performed to yield fluid samples for evaluation, which revealed no malignant cells, and polymerase chain reaction (PCR) was negative for tuberculosis. The patient underwent exploratory laparotomy which revealed a large amount of serosanguinous ascites, thickened matted bowel loops, and necrotic debris covering the entire surface of the peritoneum and visceral organs. The surgical procedures included drainage of 6.5 liters of ascites, lysis adhesion, biopsy of the peritoneum, and right salpingo-oophorectomy. Histologic examination revealed benign endometrial glands with stroma at the peritoneum tissue and broad ligament. Other causes of ascites were excluded. The ascites responded to drainage and hormonal suppression. A final diagnosis of endometriosis was made based on these findings. Endometriosis should therefore be considered in differential diagnosis in women of childbearing age who present with ascites.

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Section: Discussionsupporting

confidence: 83%

“…Reported cases have mostly been in African (82%) and nulliparous (85%) women [13]. The main presenting symptoms in these cases were abdominal distention, pain, and/or weight loss [6,[12][13][14][15][16][17][18]. Significant weight loss occurred in one-third of reported cases, and concurrent pleural effusion was found in 38% of cases [6].…”

Section: Discussionmentioning

confidence: 99%

Endometriosis-Associated Massive Ascites in an Asian Woman: A Case Report of a Rare Clinical Entity

Eamudomkarn

Likitdee

Kleebkaow

et al. 2020

Case Reports in Obstetrics and Gynecology

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“…In the cases reviewed, the CA-125 level was not helpful nor consistent, ranging from normal values to >5,000 U/mL. These patients were treated with antiinflammatory drugs, hormonal therapies, surgery, or combination therapies (2). Despite intervention, recurrence or persistence was common, but it is important to note there was a highly variable follow-up interval among the cases, with some cases reporting resolution of symptoms as early as 4 weeks.…”

mentioning

confidence: 97%

“…The knowledge of massive hemorrhagic ascites secondary to endometriosis is not new, with the first case reports published in the 1970s (2). In reviewing the literature, the paucity regarding this complication is striking.…”

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confidence: 99%

“…Despite intervention, recurrence or persistence was common, but it is important to note there was a highly variable follow-up interval among the cases, with some cases reporting resolution of symptoms as early as 4 weeks. In addition, subjective terminology, such as ''well controlled,'' ''partial response,'' and ''relatively asymptomatic,'' was used to describe the outcomes, which are hard to interpret and make the data difficult to aggregate (2). It was not reported whether the degree of disease was significantly associated with the presence of these rare severe complications or whether the diagnosis of endometriosis was made before, during, or after management of these complications.…”

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Belly full of blood: a rare presentation of endometriosis

Bernard

Lindheim

Goodman

2019

Fertility and Sterility

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Endometriosis is a chronic, benign, hormonally dependent gynecologic condition affecting 6%-10% of reproductiveage women and is one of the most prevalent diagnoses associated with chronic pelvic pain. Endometriosis is defined by the presence of endometrial glands and stroma outside of the uterine cavity, with common ectopic locations including the rectovaginal septum, abdominal wall, pelvic peritoneum, and pelvic viscera. The pathophysiology is likely multifactorial and is a result of an interplay between genetic factors, environmental stimuli, aberrant hormonal signaling, and an improper immune response. Commonly, patients present to the health care setting with complaints of abdominopelvic pain, dysmenorrhea, or deep dyspareunia, but they are often asymptomatic and as such, the presentation of endometriosis is highly variable and largely unpredictable. A rare and potentially reproductive organ threatening presentation of endometriosis is recurrent hemorrhagic ascites.The symptomatic presentation of ascites often occurs in the late stages with multiple liters of fluid causing pain, distention, and shortness of breath. In cases of hemorrhagic ascites, this can be life-threatening with presentation including anemia and hypovolemic shock. Modern imaging tools can quickly discern free fluid, but determining etiology is a more complex owing to the broad differential. In young women of reproductive age with suspected hemorrhagic ascites, once the exclusion of hemoperitoneum due to ectopic pregnancy and trauma are established, attention is turned to ruling out ovarian malignancy, ruptured ovarian cysts, and endometriosis. Because these patients are presenting with symptoms, most cases reported in the literature have been approached surgically with drainage of the fluid, evaluation of the pelvis, and plan for clinical or pathologic diagnosis.

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