Massive ascites as a presentation in a young woman with endometriosis: a case report

Objective: To report a case of endometriosis associated with massive ascites and an elevated CA-125 level. Design: Case report. Setting: Tertiary care center. Patient(s): A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer. Intervention(s): Ultrasonography, laparotomy, and bilateral ovarian cystectomy and reconstruction. Endometriosis was diagnosed postoperatively on the basis of histopathology. The patient received 6 months of treatment with a GnRH analogue. Main Outcome Measure(s): Ultrasound examination 6 months after surgery to evaluate for ascites or recurrent ovarian cysts. Result(s): Frozen sections obtained at laparotomy and ovarian cystectomy ruled out a malignancy. The final histologic report was compatible with a diagnosis of endometriosis. After 6 months of treatment with the GnRH analogue, the patient experienced a progressive reduction of the ascitic fluid and full remission after 2 years. Conclusion(s): Endometriosis associated with massive bloody ascites is an unusual occurrence. This report draws attention to this condition as a complication of endometriosis. For this reason, endometriosis should be included in the differential diagnosis of reproductive-age women presenting with an apparent ovarian malignancy. (Fertil Steril (R) 2008;90:2015.e17-e19. (C) 2008 by American Society for Reproductive Medicine.)