SHM Converge Scientific Abstract ePoster Gallery-Hemorrhagic Ascites in Endometriosis: A Rare and Overlooked Complication

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This case describes a 35-year-old woman with symptomatic uterine fibroids who presented after a syncopal episode, with a year of chronic abdominal pain that acutely worsened along with nausea, vomiting, and new abdominal distension. She had no infectious or constitutional symptoms. Initial labs showed severe anemia (hemoglobin 6.4, down from a baseline of 10) and mildly elevated bilirubin, while CT imaging revealed a hypoattenuating uterine mass, a 3.7 cm left ovarian cyst, significant ascites, and a cirrhotic-appearing liver.<br /><br />Paracentesis demonstrated hemorrhagic ascites with very high red blood cells, elevated protein, low SAAG (0.8), and negative cytology. Further evaluation found no evidence of heart failure on echocardiogram, no convincing nephrotic syndrome, and no clear organic liver disease based on normal liver tests. In the end, the ascites was attributed to rupture of a hemorrhagic ovarian cyst (endometrioma) in the setting of long-standing endometriosis.<br /><br />The discussion emphasizes that hemorrhagic ascites is a rare and often overlooked complication of endometriosis, with only about 100 reported studies since its first description in 1954. It is thought to result either from endometrioma rupture or exudation from widespread pelvic endometriosis. Patients usually present with progressive abdominal pain, distension, anorexia, and weight loss over weeks to months, though rapid onset can also occur. Importantly, many patients have not previously been diagnosed with endometriosis.<br /><br />The key learning points are to recognize endometrioma rupture as a possible cause of hemorrhagic ascites, understand its clinical presentation, and ensure proper diagnosis and monitoring of endometriomas to prevent delayed recognition of this rare complication.

Asset Subtitle

Carlin L. Lockwood

Meta Tag

Author List Carlin L. Lockwood, Dylan Yang

Category Clinical Vignettes

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Carlin L. Lockwood

Track Adult

Keywords

endometriosis