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BIBTEX RIS

Severe endometriosis may be considered in the differential diagnosis in young women presenting massive hemorrhagic ascites

2011; Springer Nature; Volume: 8; Issue: 4 Linguagem: Inglês

10.1007/s10397-011-0690-8

1613-2084

Luiz Flávio Cordeiro Fernandes, Sérgio Podgaec, G. C.C. Cotti, Maurício Simões Abrão,

Gynecological conditions and treatments

Endometriosis, the presence of endometrial tissue outside the uterine cavity, affects 10% of women in reproductive age and has immunological aspects conferring the disease an indubitable inflammatory trace [1]. Patients may present dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility but rarely develops massive hemorrhagic ascites. One of the components of peritoneal fluid in normal menstrual cycles is an ovarian exudate. The increase in vascular permeability along with some other factors as extremely high estrogen concentrations, and the presence of angiogenic factors, prostaglandins, histamines, and cytokines, may play an important role in the appearance of massive ascites. Inflammation increase the volume of exudation and, consequently, of the peritoneal fluid [2]. In the USA, cirrhosis represents 81% of the causes of ascites followed by cancer (10%), heart failure (3%), tuberculosis (2%), dialysis (1%), pancreatic disease (1%), and other causes (2%). Ovarian tumors, ovarian hyperstimulation syndrome, pelvic or peritoneal tuberculosis, and Meigs syndrome also can cause ascites. The correct and successful treatment depends on a precise diagnosis of its cause [3]. Most gynecologists are unaware that endometriosis can be related to massive ascites, leading to a misdiagnosis, especially when the symptoms includes loss of weight. To improve the knowledge of this kind of clinical case, we describe a patient that presented hemorrhagic ascites due to endometriosis [2, 4].