Skip to main content

Advertisement

Log in

Ascites in puerperium: a rare case of atypical pseudo-Meigs’ syndrome complicating the puerperium

  • Case Report
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

We report the case of puerperal ascites, associated with elevated CA125 levels and secondary to a uterine myoma. The literature on pseudo-Meigs’ syndrome associated with pregnancy was reviewed.

Case

A 35-year-old woman complained of abdominal distension 2 days after a spontaneous vaginal delivery. A mass of 5 cm in the right uterine corner had been detected during the first trimester ultrasound and had been diagnosed as subserosal myoma. Physical examination and ultrasound revealed massive ascites. Computed tomography confirmed ascites and laboratory investigations showed CA125 raised levels. Cytology of ascitic fluid resulted negative for malignancy. A laparotomy was performed and a large pedunculated myoma was removed. A final diagnosis of atypical pseudo-Meigs’ syndrome was performed, being computed tomography and chest X-ray negative for pleural effusion.

Conclusions

To the best of our knowledge, this is the first case of pseudo-Meigs’ syndrome caused by a uterine leiomyoma described in puerperium and without hydrothorax. Though ascites is very rare in obstetrics, it should be considered when evaluating puerperal patients complaining of abdominal distension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

References

  1. Gyang A, Kalu E, Fakokunde A, Whitlow B (2005) Ascites in the puerperium: a missed diagnosis of acute postpartum pancreatitis. Arch Gynecol Obstet 272:238–240. doi:10.1007/s00404-004-0717-8

    Article  PubMed  Google Scholar 

  2. Behtash N, Karimi Zarchi M, Modares Gilani M, Ghaemmaghami F, Mousavi A, Ghotbizadeh F (2008) Ovarian carcinoma associated with pregnancy: a clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth 8:3. doi:10.1186/1471-2393-8-3

    Article  PubMed  Google Scholar 

  3. Khuroo MS, Datta DV (1980) Budd-Chiari syndrome following pregnancy. Am J Med 68:113–121. doi:10.1016/0002-9343(80)90180-1

    Article  CAS  PubMed  Google Scholar 

  4. Meigs JV (1954) Pelvic tumors other than fibromas with ascites and hydrothorax. Obstet Gynecol 3:471–486

    CAS  PubMed  Google Scholar 

  5. Damman HG, Hagemann J, Runge M, Koppel G (1982) In vivo diagnosis of hepatic infarction by computed tomography. Dig Dis Sci 27:73–79. doi:10.1007/BF01308124

    Article  Google Scholar 

  6. Raheem M, Lala A, Abukhalil I (2004) An aggressive presentation of postpartum acute necrotizing pancreatitis. J Obstet Gynaecol 24:703–704. doi:10.1080/01443610400008149

    Article  CAS  PubMed  Google Scholar 

  7. Kanda K, Sari A, Nagai K, Matayoshi Y (1980) Postpartm capillary leak syndrome. A case report. Crit Care Med 8:661–662. doi:10.1097/00003246-198011000-00014

    Article  CAS  PubMed  Google Scholar 

  8. Bakri YN, Subhi J, Fawzi M (1991) Right atrial myxoma presenting as postpartum ascites and fever of unknown origin. Acta Obstet Gynecol Scand 71:74–75. doi:10.3109/00016349209007954

    Article  Google Scholar 

  9. Valko PC, McCarty D (1992) Peripartum cardiac failure in a woman with Graves disease. Am J Emerg Med 10:46–49. doi:10.1016/0735-6757(92)90125-H

    Article  CAS  PubMed  Google Scholar 

  10. Muggia RA, Mowschenson P, Chopra S (1992) Urinary ascites in the immediate postpartum period. Am J Gastroenterol 87:1196–1197

    CAS  PubMed  Google Scholar 

  11. Kibel AS, Staskin DR, Grigoriev VE (1995) Intraperitoneal bladder rupture after normal vaginal delivery. J Urol 153:725–727. doi:10.1016/S0022-5347(01)67699-7

    Article  CAS  PubMed  Google Scholar 

  12. Ozdegirmenci O, Kayikcioglu F, Haberal A, Ozfuttu A (2007) Krukenberg tumor mimicking pregnancy luteoma. Gynecol Endocrinol 23:482–485. doi:10.1080/09513590701532401

    Google Scholar 

  13. Meigs JV, Cass JW (1937) Fibroma of the ovary with ascites and hydrothorax. Am J Obstet Gynecol 33:249–266

    Google Scholar 

  14. O’Flanagan SJ, Tighe BF, Egan TG, Delaney PV (1987) Meigs’ syndrome and pseudo-Meigs’ syndrome. J R Soc Med 80:252–253

    PubMed  Google Scholar 

  15. Weise M, Westphalen S, Fayyazi A, Emons G, Krauss T (2002) Pseudo-Meigs syndrome: uterine leiomyoma with bladder attachment associated with ascites and hydrothorax—a rare case of a rare syndrome. Onkologie 25:443–446. doi:10.1159/000067439

    Article  CAS  PubMed  Google Scholar 

  16. Hsu WC, Torng PL, Chow SN, Huang SC (2004) Pseudo-Meigs’ syndrome with degenerative uterine leiomyoma in pregnancy. Taiwan J Obstet Gynecol 43:161–164

    Article  Google Scholar 

  17. Gorsse P (1952) Meigs’ syndrome and pregnancy. Maroc Med 31:907–908

    CAS  PubMed  Google Scholar 

  18. Printer KD (1967) Pseudo-Meigs’ syndrome associated with a pregnancy near term. J Obstet Gynaecol Br Commonw 74:775–776

    CAS  PubMed  Google Scholar 

  19. Jimerson SD (1973) Pseudo-Meigs’s syndrome: an unusual case with analysis of the effusions. Obstet Gynecol 42:535–537

    Article  CAS  PubMed  Google Scholar 

  20. Emerson PA, Davies JH (1955) Hydrothorax complicating ascites. Lancet 1:487–488. doi:10.1016/S0140-6736(55)90269-5

    Article  Google Scholar 

  21. Datta N, Mishkin FS, Vasinrappe P et al (1984) Radionuclide demonstration of peritoneal-pleural communication as a cause of pleural fluid. JAMA 252:210. doi:10.1001/jama.252.2.210

    Article  CAS  PubMed  Google Scholar 

  22. Alberts WM, Salem AJ, Solomon DA, Boyce G (1998) Hepatic hydrothorax: cause and management. Arch Intern Med 151:2383–2388. doi:10.1001/archinte.151.12.2383

    Article  Google Scholar 

  23. Amant F, Gabriel C, Timmerman D, Vergote I (2001) Pseudo-Meigs’ syndrome caused by a hydropic degenerating uterine leiomyoma with elevated CA 125. Gynecol Oncol 83:153–157. doi:10.1006/gyno.2001.6251

    Article  CAS  PubMed  Google Scholar 

  24. Brown RS, Marley JL, Cassoni AM (1998) Pseudo-Meigs’ syndrome due to broad ligament leiomyoma: a mimic of metastatic ovarian carcinoma. Clin Oncol 10:198–201. doi:10.1016/S0936-6555(98)80071-X

    Article  CAS  Google Scholar 

  25. Gur C, Ilan Y, Shibolet O (2004) Hepatic hydrothorax-pathophysiology, diagnosis and treatment–review of the literature. Liver Int 24:281–284. doi:10.1111/j.1478-3231.2004.0936.x

    Article  PubMed  Google Scholar 

  26. Chen A, Ho YS, Tu YC, Tang HS, Cheng TC (1988) Diaphragmatic defects as a cause of massive hydrothorax in cirrhosis of the liver. J Clin Gastroenterol 10:663–666

    Article  CAS  PubMed  Google Scholar 

  27. Martin F, Brouche S, Haidar A (1990) Demons-Meigs’ syndrome. Report of a case with ovarian tumor of the granulose. Rev Pneumol Clin 46:123–124

    CAS  PubMed  Google Scholar 

  28. Tjalma WA (2005) Ascites, pleural effusion, and CA125 elevation in an SLE patient, either a Tjalma syndrome or, due to the migrated Filshie clips, a pseudo-Meigs syndrome. Gynecol Oncol 97:288–291. doi:10.1016/j.ygyno.2004.12.022

    Article  PubMed  Google Scholar 

  29. Timmerman D, Moerman P, Vergote I (1995) Meigs’ syndrome with elevated serum CA 125 levels: two case reports and review of the literature. Gynecol Oncol 59:405–408. doi:10.1006/gyno.1995.9952

    Article  CAS  PubMed  Google Scholar 

  30. Abramov Y, Anteby SO, Fasouliotis SJ, Barak V (2002) The role of inflammatory cytokines in Meigs’ syndrome. Obstet Gynecol 99:917–919. doi:10.1016/S0029-7844(01)01602-7

    Article  CAS  PubMed  Google Scholar 

  31. Spitzer M, Kaushal N, Benjamin F (1998) Maternal CA-125 levels in pregnancy and puerperium. J Reprod Med 43:387–392

    CAS  PubMed  Google Scholar 

  32. Bedaiwy MA, Falcone T (2004) Laboratory testing for endometriosis. Clin Chim Acta 340:41–56. doi:10.1016/j.cccn.2003.10.021

    Article  CAS  PubMed  Google Scholar 

  33. Karoo R, Lloyd T, Garcea G, Redway H, Robertson G (2003) How valuable is ascitic cytology in the detection and management of malignancy? Postgrad Med J 79:292–294. doi:10.1136/pmj.79.931.292

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giuseppe Ricci.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ricci, G., Inglese, S., Candiotto, A. et al. Ascites in puerperium: a rare case of atypical pseudo-Meigs’ syndrome complicating the puerperium. Arch Gynecol Obstet 280, 1033–1037 (2009). https://doi.org/10.1007/s00404-009-1041-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1041-0

Keywords

Navigation