Severe recurrent ascites in a Pseudo-Meigs’ syndrome variant

Background: Meigs’ syndrome is the triad of ovarian neoplasm, ascites and pleural effusion, while Pseudo-Meigs’ syndrome is the presence of ascites and pleural effusion with other pelvic tumors. Ascites resolves after tumor resection. Our case does not meet classic criteria for either but is likely a variant of Pseudo-Meigs’ syndrome. Case: A 30-year-old female had multiple Emergency Department visits for abdominal pain, distention, and shortness of breath. Imaging showed severe abdominal ascites with a large leiomyomatous uterus but no pleural effusions. Multiple paracenteses revealed benign cytology. After counselling, she underwent an abdominal myomectomy which resolved her recurrent ascites. Conclusion: Variants of Pseudo-Meigs’ syndrome should be considered in the differential of abdominal pain and leiomyomas with ascites, and surgical management should be offered.