Hemorrhagic ascites in endometriosis: a case series and clinical implications.

Abstract

Background: Hemorrhagic ascites is a rare clinical manifestation of endometriosis, often misdiagnosed due to its resemblance to malignancy. This study aims to highlight diagnostic and management challenges by presenting three cases.

Case presentation: Three nulliparous women presented with abdominal distension, pelvic pain, and large-volume bloody ascites. One had concurrent right-sided hemorrhagic pleural effusions. Imaging studies showed deep infiltrating endometriosis (DIE) without ovarian endometriomas in two patients. Laparoscopic surgery confirmed extensive endometriosis with 2-4 L of bloody ascitic fluid. Histopathological examination excluded malignancy and confirmed endometriosis. Postoperative medical therapy included hormonal suppression.

Conclusion: Bloody ascites is an uncommon but important presentation of severe endometriosis. These cases highlight the importance of considering endometriosis in the differential diagnosis of bloody ascites, particularly in reproductive-aged women. Surgical diagnosis and histopathologic confirmation are essential to rule out malignancy. A multidisciplinary approach and individualized fertility planning are crucial in managing these complex cases.