Endometriosis Presenting as Massive Hemorrhagic Ascites

Authors: Sarah E Mitchell,  Martin Healey,  Claudia Cheng, Uri Dior


Massive hemorrhagic ascites secondary to endometriosis is a rare phenomenon that most practising gynaecologists will never encounter. We present the case of a 31 year-old woman who presented with progressive abdominal distension over a 5 month period. She had a past history of surgically diagnosed endometriosis. She had in fact been pain-free and otherwise asymptomatic for 5 years. She was found to have massive hemorrhagic ascites considered secondary to endometriosis. At laparoscopy 4.8 litres of fluid was drained and she had stage IV endometriosis with a frozen pelvis. Due to a lack of pain symptoms the patient declined surgical resection of the endometriosis. She was treated with a goserelin acetate implant. On ultrasound examination the ascites recurred, however remained a small stable volume over repeated scans. This case report is followed by a brief review of what is currently known of the epidemiology, clinical features, pathophysiology and management of this unusual condition.


Endometriosis, hemorrhagic ascites

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Endometriosis Presenting as Massive Hemorrhagic Ascites