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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(03): 147-155
DOI: 10.1055/s-0038-1626700
Review Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Ascites and Encapsulating Peritonitis in Endometriosis: a Systematic Review with a Case Report

Endometriose com ascite e peritonite encapsulante: uma revisão sistemática com descrição de um caso clínico
Thais Fontes de Magalhães
1   Department of Gynecology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Kathiane Lustosa Augusto
1   Department of Gynecology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
2   Department of Gynecology, Universidade de Fortaleza, Fortaleza, CE, Brazil
,
Livia Ponte Mota
3   Department of Internal Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
,
Arthur Ribeiro da Costa
3   Department of Internal Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
,
Rainardo Antonio Puster
3   Department of Internal Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
,
Leonardo Robson Pinheiro Sobreira Bezerra
1   Department of Gynecology, Universidade Federal do Ceará, Fortaleza, CE, Brazil
› Author Affiliations
Further Information

Publication History

12 September 2017

20 December 2017

Publication Date:
19 March 2018 (online)

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Abstract

Endometriosis can have several different presentations, including overt ascites and peritonitis; increased awareness can improve diagnostic accuracy and patient outcomes. We aim to provide a systematic review and report a case of endometriosis with this unusual clinical presentation. The PubMed/MEDLINE database was systematically reviewed until October 2016. Women with histologically-proven endometriosis presenting with clinically significant ascites and/or frozen abdomen and/or encapsulating peritonitis were included; those with potentially confounding conditions were excluded. Our search yielded 37 articles describing 42 women, all of reproductive age. Ascites was mostly hemorrhagic, recurrent and not predicted by cancer antigen 125 (CA-125) levels. In turn, dysmenorrhea, dyspareunia and infertility were not consistently reported. The treatment choices and outcomes were different across the studies, and are described in detail. Endometriosis should be a differential diagnosis of massive hemorrhagic ascites in women of reproductive age.

Resumo

A endometriose pode ter várias apresentações, incluindo ascite e peritonite, que são apresentações incomuns. O aumento da conscientização sobre essa doença pode melhorar a precisão diagnóstica e os resultados das pacientes. Nosso objetivo é fornecer uma revisão sistemática e relatar um caso de endometriose com esta apresentação clínica incomum. O banco de dados PubMed/MEDLINE foi revisado sistematicamente até outubro de 2016. Foram incluídas mulheres com endometriose demonstrada histologicamente, com presença de ascite clinicamente significativa e/ou abdômen congelado e/ou peritonite encapsulante; foram excluídas aquelas com comorbidades que pudessem provocar confusão. A pesquisa selecionou 37 artigos que descrevem 42 mulheres, todas em idade reprodutiva. A ascite foi principalmente hemorrágica, recorrente, e não indicada pelos níveis de antígeno associado ao câncer 125 (AC-125). Por sua vez, a dismenorreia, a dispareunia e a infertilidade não foram relatadas de forma consistente. As escolhas e os resultados do tratamento foram diferentes entre os estudos, e são descritos em detalhes. A endometriose deveria ser um diagnóstico diferencial de ascite hemorrágica maciça em mulheres em idade reprodutiva.

Keywords

endometriosis - ascites - peritonitis - systematic review - treatment

Palavras-chave

endometriose - ascite - peritonite - revisão sistemática - tratamento

Contributors

Magalhaes TF, Augusto KL, Mota LP, Costa AR, Puster RA, and Bezerra LRPS contributed with the project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.


Supplementary Material

 

  • References

  • 1 Chen P, Wang DB, Liang YM. Evaluation of estrogen in endometriosis patients: Regulation of GATA-3 in endometrial cells and effects on Th2 cytokines. J Obstet Gynaecol Res 2016; 42 (06) 669-677 . Doi: 10.1111/jog.12957
    CrossrefPubMedGoogle Scholar
  • 2 Vinci G, Arkwright S, Audebourg A. , et al. Correlation between the clinical parameters and tissue phenotype in patients affected by deep-infiltrating endometriosis. Reprod Sci 2016; 23 (09) 1258-1268 . Doi: 10.1177/1933719116638188
    CrossrefPubMedGoogle Scholar
  • 3 Cheong EC, Lim DT. Massive ascites--an uncommon presentation of endometriosis. Singapore Med J 2003; 44 (02) 98-100
    PubMedGoogle Scholar
  • 4 Obaid O, Alhalabi D, Ghonami M. Intestinal obstruction in a patient with sclerosing encapsulating peritonitis. Case Rep Surg 2017; 2017: 8316147
    PubMedGoogle Scholar
  • 5 Frigerio L, Taccagni GL, Mariani A, Mangili G, Ferrari A. Idiopathic sclerosing peritonitis associated with florid mesothelial hyperplasia, ovarian fibromatosis, and endometriosis: a new disorder of abdominal mass. Am J Obstet Gynecol 1997; 176 (03) 721-722 . Doi: 10.1016/S0002-9378(97)70581-7
    CrossrefPubMedGoogle Scholar
  • 6 Santos VM, Barbosa Jr ER, Lima SH, Porto AS. Abdominal cocoon associated with endometriosis. Singapore Med J 2007; 48 (09) e240-e242
    PubMedGoogle Scholar
  • 7 Suchetha S, Rema P, Mathew AP, Sebastian P. Endometriosis with massive hemorrhagic ascites. Indian J Cancer 2010; 47 (02) 224-225 . Doi: 10.4103/0019-509X.63004
    CrossrefPubMedGoogle Scholar
  • 8 Mohd Noor NH, Zaki NM, Kaur G, Naik VR, Zakaria AZ. Abdominal cocoon in association with adenomyosis and leiomyomata of the uterus and endometriotic cyst : unusual presentation. Malays J Med Sci 2004; 11 (01) 81-85
    PubMedGoogle Scholar
  • 9 Gupta D, Hull ML, Fraser I. , et al. Endometrial biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 4: CD012165 . Doi: 10.1002/14651858.CD012165
    PubMedGoogle Scholar
  • 10 Liu E, Nisenblat V, Farquhar C. , et al. Urinary biomarkers for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2015; (12) CD012019 . Doi: 10.1002/14651858.CD012019
    PubMedGoogle Scholar
  • 11 Shabeerali TU, Rajan R, Kuruvilla AP. , et al. Hemorrhagic ascites: are we missing endometriosis?. Indian J Gastroenterol 2012; 31 (04) 195-197 . Doi: 10.1007/s12664-012-0221-1
    CrossrefPubMedGoogle Scholar
  • 12 Muneyyirci-Delale O, Neil G, Serur E, Gordon D, Maiman M, Sedlis A. Endometriosis with massive ascites. Gynecol Oncol 1998; 69 (01) 42-46 . Doi: 10.1006/gyno.1998.4953
    CrossrefPubMedGoogle Scholar
  • 13 Schlueter FJ, McClennan BL. Massive ascites and pleural effusions associated with endometriosis. Abdom Imaging 1994; 19 (05) 475-476
    CrossrefPubMedGoogle Scholar
  • 14 Cantor JO, Fenoglio CM, Richart RM. A case of extensive abdominal endometriosis. Am J Obstet Gynecol 1979; 134 (07) 846-847 . Doi: 10.1016/0002-9378(79)90958-X
    CrossrefPubMedGoogle Scholar
  • 15 Williams RS, Wagaman R. Endometriosis associated with massive ascites and absence of pelvic peritoneum. Am J Obstet Gynecol 1991; 164 (1 Pt 1): 45-46 . Doi: 10.1016/0002-9378(91)90621-W
    CrossrefPubMedGoogle Scholar
  • 16 Mejia EM, Alvarez OA, Lee M. Endometriosis with massive bloody ascites. J Am Board Fam Pract 1997; 10 (01) 59-61
    PubMedGoogle Scholar
  • 17 Bhojawala J, Heller DS, Cracchiolo B, Sama J. Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecol Obstet 2000; 264 (01) 39-41 . Doi: 10.1007/PL00007484
    CrossrefPubMedGoogle Scholar
  • 18 Ignacio MM, Joseph N, Hélder F, Mamourou K, Arnaud W. Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol 2010; 149 (01) 117-118 . Doi: 10.1016/j.ejogrb.2009.10.017
    CrossrefPubMedGoogle Scholar
  • 19 Moffatt SD, Mitchell JD. Massive pleural endometriosis. Eur J Cardiothorac Surg 2002; 22 (02) 321-323 . Doi: 10.1016/S1010-7940(02)00277-4
    CrossrefPubMedGoogle Scholar
  • 20 Palayekar M, Jenci J, Carlson Jr JA. Recurrent hemorrhagic ascites: a rare presentation of endometriosis. Obstet Gynecol 2007; 110 (2 Pt 2): 521-522
    CrossrefPubMedGoogle Scholar
  • 21 Flanagan KL, Barnes NC. Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature. Thorax 1996; 51 (10) 1062-1063 . Doi: 10.1136/thx.51.10.1062
    CrossrefPubMedGoogle Scholar
  • 22 Bignall J, Arambage K, Vimplis S. Endometriosis: a rare and interesting cause of recurrent haemorrhagic ascites. BMJ Case Rep 2014; 2014: bcr2013010052 . Doi: 10.1136/bcr-2013-010052
    CrossrefPubMedGoogle Scholar
  • 23 Fortier D, Dedecker F, Gabriele M, Graesslin O, Barau G. [Endometriosis with ascites and pleural effusion: a case report]. Gynecol Obstet Fertil 2005; 33 (7-8): 508-510 . Doi: 10.1016/j.gyobfe.2005.05.014
    CrossrefPubMedGoogle Scholar
  • 24 Setubal A, Sidiropoulou Z, Soares S, Barbosa C. Endometriosis and ascites: a strategy to achieve pregnancy. J Minim Invasive Gynecol 2015; 22 (06) 1104-1108 . Doi: 10.1016/j.jmig.2015.05.013
    CrossrefPubMedGoogle Scholar
  • 25 Samora-Mata J, Feste JR. Endometriosis ascites: a case report. JSLS 1999; 3 (03) 229-231
    PubMedGoogle Scholar
  • 26 Naraynsingh V, Raju GC, Ratan P, Wong J. Massive ascites due to omental endometriosis. Postgrad Med J 1985; 61 (716) 539-540 . Doi: 10.1136/pgmj.61.716.53
    CrossrefPubMedGoogle Scholar
  • 27 Olubuyide IO, Adebajo AO, Adeleye JA, Solanke TF. Massive ascites associated with endometriosis in a Nigerian African. Int J Gynaecol Obstet 1988; 27 (03) 439-441 . Doi: 10.1016/0020-7292(88)90127-0
    CrossrefPubMedGoogle Scholar
  • 28 Appleby R, Saroya H, Postgate A, Meer Z. A young woman with abdominal distension. BMJ Case Rep 2014; 2014: bcr2014203726 . Doi: 10.1136/bcr-2014-203726
    CrossrefPubMedGoogle Scholar
  • 29 Dun EC, Wong S, Lakhi NA, Nehzat CH. Recurrent massive ascites due to mossy endometriosis. Fertil Steril 2016; 106 (06) e14 . Doi: 10.1016/j.fertnstert.2016.07.1119
    CrossrefPubMedGoogle Scholar
  • 30 Asano R, Nakazawa T, Hirahara F, Sakakibara H. Dienogest was effective in treating hemorrhagic ascites caused by endometriosis: a case report. J Minim Invasive Gynecol 2014; 21 (06) 1110-1112 . Doi: 10.1016/j.jmig.2014.04.014
    CrossrefPubMedGoogle Scholar
  • 31 Chichareon SB, Wattanakitkrailert S. Endometriosis with ascites. Acta Obstet Gynecol Scand 1988; 67 (02) 187-188 . Doi: 10.3109/00016348809004198
    CrossrefPubMedGoogle Scholar
  • 32 Jose R, George SS, Seshadri L. Massive ascites associated with endometriosis. Int J Gynaecol Obstet 1994; 44 (03) 287-288 . Doi: 10.1016/0020-7292(94)90185-6
    CrossrefPubMedGoogle Scholar
  • 33 Myers TJ, Arena B, Granai CO. Pelvic endometriosis mimicking advanced ovarian cancer: presentation with pleural effusion, ascites, and elevated serum CA 125 level. Am J Obstet Gynecol 1995; 173 (3 Pt 1): 966-967
    CrossrefPubMedGoogle Scholar
  • 34 Jeanes AC, Murray D, Davidson B, Hamilton M, Watkinson AF. Case report: hepatic and retro-peritoneal endometriosis presenting as obstructive jaundice with ascites: a case report and review of the literature. Clin Radiol 2002; 57 (03) 226-229 . Doi: 10.1053/crad.2001.0667
    CrossrefPubMedGoogle Scholar
  • 35 Zeppa P, Vetrani A, Cozzolino I, Palombini L. Endometrial glands in ascites secondary to endometriosis. Diagn Cytopathol 2004; 30 (02) 131-132 . Doi: 10.1002/dc.10390
    CrossrefPubMedGoogle Scholar
  • 36 Ferrero S, Remorgida V. Endometriosis presenting with hemorrhagic ascites. Arch Gynecol Obstet 2011; 283 (06) 1429-1430 . Doi: 10.1007/s00404-010-1796-3
    CrossrefPubMedGoogle Scholar
  • 37 Lin JN, Lin HL, Huang CK. , et al. Endometriosis presenting as bloody ascites and shock. J Emerg Med 2010; 38 (01) 30-32 . Doi: 10.1016/j.jemermed.2008.03.031
    CrossrefPubMedGoogle Scholar
  • 38 Sait KH. Massive ascites as a presentation in a young woman with endometriosis: a case report. Fertil Steril 2008; 90 (05) 2015.e17-2015.e19
    CrossrefPubMedGoogle Scholar
  • 39 Park BJ, Kim TE, Kim YW. Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma. J Obstet Gynaecol Res 2009; 35 (05) 935-939 . Doi: 10.1111/j.1447-0756.2009.01122.x
    CrossrefPubMedGoogle Scholar
  • 40 Hasdemir PS, Ikiz N, Ozcakir HT, Kara E, Guvenal T. Endometriosis associated with relapsing ascites and pleural effusions. J Obstet Gynaecol 2015; 35 (04) 419 . Doi: 10.3109/01443615.2014.948823
    CrossrefPubMedGoogle Scholar
  • 41 Cosma S, Ceccaroni M, Benedetto C. A pseudoneoplastic finding of deep endometriosis: laparoscopic triple segmental bowel resection. Wideochir Inne Tech Malo Inwazyjne 2014; 9 (03) 463-467 . Doi: 10.5114/wiitm.2014.41617
    PubMedGoogle Scholar
  • 42 Hinduja I, Kapadia K, Udwadia F, Bhilawadikar R, Adhe A, Zaveri K. Unusual presentation of endometriosis with haemorrhagic ascites - A case report. J Obstet Gynaecol 2016; 36 (01) 133-134 . Doi: 10.3109/01443615.2015.1030605
    CrossrefPubMedGoogle Scholar
  • 43 Streuli I, Gaitzsch H, Wenger JM, Petignat P. Endometriosis after menopause: physiopathology and management of an uncommon condition. Climacteric 2017; 20 (02) 138-143 . Doi: 10.1080/13697137.2017.1284781
    CrossrefPubMedGoogle Scholar
  • 44 Meigs JV, Armstrong SH, Hamilton HH. A further contribution to the syndrome of fibroma of the ovary with fluid in the abdomen and chest, Meigs' syndrome. Am J Obstet Gynecol 1943; 46: 19-37 . Doi: 10.1016/S0002-9378(16)40440-0
    CrossrefPubMedGoogle Scholar
  • 45 Bernstein JS, Perlow V, Brenner JJ. Massive ascites due to endometriosis. Am J Dig Dis 1961; 6: 1-6 . Doi: 10.1007/BF02239240
    CrossrefPubMedGoogle Scholar
  • 46 Sherer DM, Eliakim R, Abulafia O. The role of angiogenesis in the accumulation of peritoneal fluid in benign conditions and the development of malignant ascites in the female. Gynecol Obstet Invest 2000; 50 (04) 217-224 . Doi: 10.1159/00001032
    CrossrefPubMedGoogle Scholar
  • 47 Ussia A, Betsas G, Corona R, De Cicco C, Koninckx PR. Pathophysiology of cyclic hemorrhagic ascites and endometriosis. J Minim Invasive Gynecol 2008; 15 (06) 677-681 . Doi: 10.1016/j.jmig.2008.08.012
    CrossrefPubMedGoogle Scholar