Samora-Mata, J., & Feste, J. R. (1999). Endometriosis ascites: a case report. JSLS : Journal of the Society of Laparoendoscopic Surgeons, 3(3), 229-231.
Samora-Mata J, Feste JR. Endometriosis ascites: a case report. JSLS. 1999;3(3):229-231.
Samora-Mata, J., and J. R. Feste. "Endometriosis ascites: a case report." JSLS : Journal of the Society of Laparoendoscopic Surgeons, vol. 3, no. 3, 1999, pp. 229-231.
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RRM Academy Synopsis
Endometriosis with massive ascites is a very rare complication
In a 43-year-old woman with Stage IV endometriosis and acute abdominal pain, surgeons found a ruptured endometrioma and about 2000 cc of abdominal fluid, called ascites. The case report describes the surgery and reviews earlier reports. The authors say to consider endometriosis whenever ascites and a pelvic mass occur together.
Key Findings
The patient was 43, Gravida 3 Para 3, with acute right lower quadrant pain and a history of generalized abdominal bloating since 1990.
Surgery found about 2000 cc of ascitic fluid, endometrial implants across the abdominal wall, omentum, bowel and pelvic organs, and a ruptured endometrioma on the right ovary.
Fluid cultures were negative, and the pelvic tissues showed no signs of inflammation.
In the authors' review of cases since 1954, the average age was 27 years, and pleural effusions were present in 33% of reported cases.
The authors state that ascites has been suppressed with hormonal therapy, and that it appears promising for women wishing to retain their fertility.
Interpretation
This is a single case report, plus a brief review of earlier reports. A report of one patient shows that an event can happen. The authors call endometriosis with massive ascites very rare, with fewer than 20 cases reported since 1954. Their patient was older than the average patient in earlier reports. The authors note that the exact cause of ascites in endometriosis remains obscure.
RRM Context
The patient had Stage IV endometriosis treated in 1990 by laparoscopic vaporization, which is ablation. RRM surgeons favor excision, which removes the disease. The authors call hormonal therapy promising for ascites in women wishing to retain their fertility. Suppressive medications control disease and leave it in place.
Our editorial summary of this paper, not the article's abstract.
Abstract
This is a case presentation of an usual nature, a 43-year-old Hispanic female, multigravida presenting with physical findings of massive ascites. In most instances, the presence of massive ascites is associated with malignancies, tuberculosis or perforated visous. In this case, the diagnosis of extensive endometriosis with ascites is reported as a very rare complication of the disease.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
