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A systematic review: endometriosis presenting with ascites

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

Abstract

Background

The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion.

Methods

To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired.

Results

Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites.

Conclusion

Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.

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References

  1. Rochling FA, Zetterman RK (2009) Management of ascites. Drugs 69(13):1739–1760

    Article  CAS  PubMed  Google Scholar 

  2. Witz CA (2002) Pathogenesis of endometriosis. Gynecol Obstet Invest 53(suppl 1):52–62

    Article  PubMed  Google Scholar 

  3. Howard FM (2009) Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol 16(5):540–550

    Article  PubMed  Google Scholar 

  4. Daniels J, Gray R, Hills RK (2009) Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 302:955–961

    Article  CAS  PubMed  Google Scholar 

  5. Givens V, Mitchell GE, Harraway-Smith C, Reddy A, Maness DL (2009) Diagnosis and management of adnexal masses. Am Fam Physician 80(8):815–820

    PubMed  Google Scholar 

  6. Cheng MH, Yen MS, Chao KC, Sheu BC, Wang PH (2008) Differential diagnosis of gynecologic organ-related diseases in women presenting with ascites. Taiwan J Obstet Gynecol 47(4):384–390

    Article  PubMed  Google Scholar 

  7. Gostout BS, Brewer MA (2006) Guidelines for the referral of the patient with adnexal mass. Clin Obstet Gynecol 49(3):448–458

    Article  PubMed  Google Scholar 

  8. Brews A (1954) Endometriosis including endometriosis of the diaphragm and Meigs’ syndrome. Proc Roy Soc Med 47:461

    Google Scholar 

  9. Charles D (1957) Endometriosis and hemorrhagic pleural effusion. Obstet Gynecol 10:309–312

    CAS  PubMed  Google Scholar 

  10. Boles RS, Hodes RJ (1958) Endometriosis of the large and small intestine. Gastroenterology 34:367–380

    CAS  PubMed  Google Scholar 

  11. Ripstein CB, Rohman M, Wallach JB (1959) Endometriosis involving the pleura. J Thorac Cardiovasc Surg 37:464–471

    CAS  Google Scholar 

  12. Bernstein JS, Perlow V, Brenner JJ (1961) Massive ascites due to endometriosis. Am J Dig Dis 6:1–7

    Article  Google Scholar 

  13. Irani S, Atkinson L, Cabaniss S, Danovitch SH (1976) Pleuroperitoneal endometriosis. Obstet Gynecol 47:72s–74s

    CAS  PubMed  Google Scholar 

  14. Cantor JO, Fenoglio CM, Richart RM (1979) A case of extensive abdominal endometriosis. Am J Obstet Gynecol 134:846–847

    CAS  PubMed  Google Scholar 

  15. Chervenak F, Greenlee RM, Lewenstein L, Tovell HMM (1981) Massive ascites associated with endometriosis. Obstet Gynecol 57:379–381

    CAS  PubMed  Google Scholar 

  16. Gaulier A, Jouret-Mourin A, Marsan C (1983) Peritoneal endometriosis: a report of a case with cytologic, cytochemical and histopathologic study. Acta Cytol 27:446–449

    CAS  PubMed  Google Scholar 

  17. Jenks JE, Artman LE, Hoskins WJ, Miremadi AK (1984) Endometriosis with ascites. Obstet Gynecol 63:75s–77s

    CAS  PubMed  Google Scholar 

  18. Halme J, Chafe W, Currie JL (1985) Endometriosis with massive ascites. Obstet Gynecol 65:591–592

    CAS  PubMed  Google Scholar 

  19. Iwasaka T, Okuma Y, Yoshimura T, Kidera Y, Sugimori H (1985) Endometriosis associated with ascites. Obstet Gynecol 66:72s–75s

    CAS  PubMed  Google Scholar 

  20. Naraysingh V, Raju GC, Ratan P, Wong J (1985) Massive ascites due to omental endometriosis. Postgrad Med J 61:539–540

    Article  Google Scholar 

  21. Chichareon SB, Wattanakitkrailert S (1988) Endometriosis with ascites. Acta Obstet Gynecol Scand 67:187–188

    Article  CAS  PubMed  Google Scholar 

  22. Feigin RD, Glikson M, Gur H, Galun E, Younis JF, Beyth Y (1988) Induction of ovulation causing recurrent bloody ascites in a woman with endometriosis. Am J Obstet Gynecol 159:1161–1162

    CAS  PubMed  Google Scholar 

  23. Olubuyide IO, Adebajo AO, Adeleye JA, Solanke TF (1988) Massive ascites associated with endometriosis in a Nigerian-African. Int J Gynaecol Obstet 27:439–441

    Article  CAS  PubMed  Google Scholar 

  24. Meinen K, Crusius M, Schulz U (1989) Turner syndrome with peritoneal endometriosis and ascites—therapeutic effects of buserelin therapy. Arch Gynecol Obstet 245(1–4):943–945

    Article  CAS  PubMed  Google Scholar 

  25. Taub WH, Rosado S, Kalaycioglu M, Booher D, Barnes DS (1989) Hemorrhagic ascites secondary to endometriosis. J Clin Gastroenterol 11:458–460

    Article  CAS  PubMed  Google Scholar 

  26. Hattori S, Tamakoshi K, Oguchi H, Kodama H (1990) A case of endometriosis with massive ascites. Nippon Sanka Fujinka Gakkai Zasshi 42(3):291–294

    CAS  PubMed  Google Scholar 

  27. Tsvelev IuV, Lishchuk VD, Kolosov AE (1990) Ascites as a manifestation of generalized endometriosis. Vestn Khir Im I I Grek 145(7):48–50

    PubMed  Google Scholar 

  28. Williams RS, Wagaman R (1991) Endometriosis associated with massive ascites and absence of pelvic peritoneum. Am J Obstet Gynecol 164:45–46

    CAS  PubMed  Google Scholar 

  29. Yu J, Grimes D (1991) Ascites and pleural effusion associated with endometriosis. Obstet Gynecol 78:533–534

    CAS  PubMed  Google Scholar 

  30. Chen FF, Chow NH, Chou CY, Lin MF (1992) Hemorrhagic ascites associated with endometriosis: a rare clinical presentation. J Gynecol Surg 8:43–47

    Article  Google Scholar 

  31. Charran D, Roopnarinesingh S (1993) Hemothorax and ascites associated with endometriosis. West Indian Med J 42:40–41

    CAS  PubMed  Google Scholar 

  32. London S, Parmley T (1993) Endometriosis and ascites. South Med J 86:1173–1175

    Article  CAS  PubMed  Google Scholar 

  33. Jose R, George SS, Seshadri L (1994) Massive ascites associated with endometriosis. Int J Gynaecol Obstet 44(3):287–288

    Article  CAS  PubMed  Google Scholar 

  34. Schlueter FJ, McClennan BL (1994) Massive ascites and pleural effusions associated with endometriosis. Abdom Imaging 19:475–476

    Article  CAS  PubMed  Google Scholar 

  35. El-Newihi HM, Antaki JP, Rajan S, Reynolds TB (1995) Large bloody ascites in association with pelvic endometriosis: case report and literature review. Am J Gastroenterol 90(4):632–634

    CAS  PubMed  Google Scholar 

  36. Myers TJ, Arena B, Granai CO (1995) Pelvic endometriosis mimicking advanced ovarian cancer: presentation with pleural effusion, ascites, and elevated serum CA125 level. Am J Obstet Gynecol 173:966–967

    Article  CAS  PubMed  Google Scholar 

  37. Shek Y, De-Lia JE, Patillo RA (1995) Endometriosis with pleural effusion and ascites. Report of a case treated with nafarelin acetate. J Reprod Med 40(7):540–542

    CAS  PubMed  Google Scholar 

  38. Spitzer M, Benjamin F (1995) Ascites due to endometriosis. Obstet Gynecol Surv 50(8):628–631

    Article  CAS  PubMed  Google Scholar 

  39. Flanagan KL, Barnes NC (1996) Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature. Thorax 51:1062–1063

    Article  CAS  PubMed  Google Scholar 

  40. Mejia EM, Alvarez OA, Lee M (1997) Endometriosis with massive bloody ascites. J Am Board Fam Pract 10(1):59–61

    CAS  PubMed  Google Scholar 

  41. Muneyyirci-Delale O, Neil G, Seur E, Gordon D, Maiman M, Sedlis A (1998) Endometriosis with massive ascites. Gynecol Oncol 69:42–46

    Article  CAS  PubMed  Google Scholar 

  42. Fletcher H, McFarlane M, Shirley SE, Clarke WF, Lyon K (1999) Massive ascites secondary to severe endometriosis. West Indian Med J 48:158–159

    CAS  PubMed  Google Scholar 

  43. El Khalil T, Mourad FH, Barada K, Uthman S (1999) Massive hemorrhagic ascites secondary to endometriosis. J Clin Gastroenterol 29:344–345

    Article  CAS  PubMed  Google Scholar 

  44. Samora-Mata J, Feste JR (1999) Endometriosis ascites: a case report. JSLS 3:229–231

    CAS  PubMed  Google Scholar 

  45. Bhojawala J, Heller DS, Cracchiolo B, Sama J (2000) Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecol Obstet 264:39–41

    Article  CAS  PubMed  Google Scholar 

  46. Dias CC, Andrade JM, Ferriani RA, Villanova MG, Meirelles R (2000) Hemorrhagic ascites associated with endometriosis. A case report. J Reprod Med 45(8):688–690

    CAS  PubMed  Google Scholar 

  47. Jeanes AC, Murray D, Davidson B, Hamilton M, Watkinson AF (2002) Case report: hepatic and retroperitoneal endometriosis presenting as obstructive jaundice with ascites: a case report and review of the literature. Clin Radiol 57:226–229

    Article  CAS  PubMed  Google Scholar 

  48. Moffatt SD, Mitchell JD (2002) Case report: massive pleural endometriosis. Eur J Cardiothorac Surg 22:321–323

    Article  CAS  PubMed  Google Scholar 

  49. Cheong EC, Lim DT (2003) Massive ascites-an uncommon presentation of endometriosis. Singap Med J 44:98–100

    CAS  Google Scholar 

  50. Francis M, Badero OO, Borowsky M, Lee YC, Abulafia O (2003) Pericardial effusion, right-sided pleural effusion and ascites associated with stage IV endometriosis. A case report. J Reprod Med 48(6):463–465

    PubMed  Google Scholar 

  51. Zeppa P, Vetrani A, Cozzolino I, Palombini L (2004) Endometrial glands in ascites secondary to endometriosis. Diagn Cytopathol 30(2):131–132

    Article  PubMed  Google Scholar 

  52. Donnez J, Jadoul P (2005) Ascites and pelvic masses: an unusual case of endometriosis. Fertil Steril 83:195–197

    Article  PubMed  Google Scholar 

  53. Ekoukou D, Guilherme R, Desligneres S, Rotten D (2005) Endometriosis with massive hemorrhagic ascites: a case report and review of the literature (French). J Gynecol Obstet Biol Reprod 34(4):351–359

    CAS  Google Scholar 

  54. Fortier D, Dedecker F, Gabriele M, Graesslin O, Barau G (2005) Endometriosis with ascites and pleural effusion: a case report (French). Gynécol Obstét Fertil 33:508–510

    Article  CAS  PubMed  Google Scholar 

  55. Goumenou A, Matalliotakis I, Mahutte N, Koumantakis E (2006) Endometriosis mimicking advanced ovarian cancer. Fertil Steril 86:219.e23–219.e25

    Google Scholar 

  56. Mwenechanya S, Beck I (2007) Unusual presentation of endometriosis with massive ascites and recurrent pleural effusion: a case report and review of the literature. Gynecol Surg 4:57–59

    Article  Google Scholar 

  57. Palayekar M, Jenci J, Carlson JA Jr (2007) Recurrent hemorrhagic ascites: a rare presentation of endometriosis. Obstet Gynecol 110(2 Pt 2):521–522

    Article  PubMed  Google Scholar 

  58. Sait KH (2008) Massive ascites as a presentation in a young woman with endometriosis: a case report. Fertil Steril 90(5):2015.e17–2015.e19

  59. Sakpal SV, Patel C, Chamberlain RS (2009) Near lethal endometriosis and a massive (64 kg) endometrioma: case report and review of the literature. Clin Exp Obstet Gynecol 36(1):49–52

    CAS  PubMed  Google Scholar 

  60. Haeri S, Cosin JA (2009) Endometriosis mimicking ovarian cancer in the setting of acquired immune deficiency syndrome. Obstet Gynecol 114(2 Pt 2):425–426

    Article  PubMed  Google Scholar 

  61. Park BJ, Kim TE, Kim YW (2009) Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma. J Obstet Gynecol Res 35(5):935–939

    Article  Google Scholar 

  62. Ignacio MM, Mamourou K, Arnaud W (2010) Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol 149:117–123

    Article  PubMed  Google Scholar 

  63. Lin JN, Lin HL, Huang CK, Lai CH, Chung HC, Liang SH, Lin HH (2010) Endometriosis presenting as bloody ascites and shock. J Emerg Med 38(1):30–32

    Article  PubMed  Google Scholar 

  64. Suchetha S, Rema P, Mathew AP, Sebastian P (2010) Endometriosis with massive hemorrhagic ascites. Indian J Cancer 47(2):224–225

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We acknowledge our colleagues for their help in the translation of non-English papers.

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Correspondence to Mine Kanat-Pektas.

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Gungor, T., Kanat-Pektas, M., Ozat, M. et al. A systematic review: endometriosis presenting with ascites. Arch Gynecol Obstet 283, 513–518 (2011). https://doi.org/10.1007/s00404-010-1664-1

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  • DOI: https://doi.org/10.1007/s00404-010-1664-1

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