title: Hemorrhagic ascites: are we missing endometriosis?
abstract: Peritoneal tuberculosis, carcinomatosis and pancreatic ascites are often considered as differential diagnosis of hemorrhagic ascites. Endometriosis can rarely present as hemorrhagic ascites and closely mimic these conditions. When this occurs without common clinical features of endometriosis, it can create a diagnostic challenge to the treating physician. We present three patients with endometriosis who presented with hemorrhagic ascites; two of them did not have gynecological symptoms or significant pelvic disease. These patients were evaluated several times in many centers and even received multiple courses of anti-tuberculous treatment. The diagnosis was made by histologic examination of parietal peritoneum obtained by laparoscopy or laparotomy. The diagnosis was missed possibly because of the atypical presentation, lack of clinical suspicion and incomplete assessment. In conclusion, this potentially treatable condition should be considered as a differential diagnosis for hemorrhagic ascites in a premenopausal woman.
authors: Department of Surgical Gastroenterology, Medical College, Trivandrum, 695 011 Kerala, India. drshabeeralitu@yahoo.com
authors: T U
authors: TU
authors: Shabeerali
authors: Ramesh
authors: R
authors: Rajan
authors: A P
authors: AP
authors: Kuruvilla
authors: Selwyn
authors: S
authors: Noronha
authors: Devadas
authors: D
authors: Krishnadas
authors: K T
authors: KT
authors: Shenoy
authors: M
authors: M
authors: Manjula
authors: Sheela
authors: S
authors: Shenoy
authors: N Laila
authors: NL
authors: Raji
mesh_terms: D000328:Adult; D001201:Ascites / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy