Dienogest was effective in treating hemorrhagic ascites caused by endometriosis: a case report.
Hemorrhagic ascites caused by endometriosis is extremely rare, and its treatment is under discussion. We report a case of recurrent endometriosis-related ascites treated with dienogest (DNG). A 35-year-old nulliparous Japanese woman with a history of infertility presented with worsening dysmenorrhea and abdominal distention caused by massive ascites. The patient underwent exploratory laparotomy, and hemorrhagic ascites (5500 mL) was drained. She had a normal-sized uterus, and the bilateral ovaries could not be observed because of extensive adhesion in the abdominal cavity. Endometriosis was diagnosed by histopathological evaluation of the omental biopsy, and this was considered to be the cause of ascites. After laparotomy, she had recurrence of ascites. For the next 8 years, the patient was treated conservatively with gonadotropin-releasing hormone agonist therapy and drainage during the intermittent periods followed by DNG administration. She has been treated continuously with DNG for 1 year with no recurrence of ascites. DNG could be an effective treatment for recurrent ascites associated with endometriosis, especially when surgical therapy is undesirable.
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan. Electronic address: new_official_asano@hotmail.co.jp.
Ryoko
R
Asano
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Tsuneo
T
Nakazawa
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Fumiki
F
Hirahara
Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan.
Hideya
H
Sakakibara
D000328:Adult; D001201:Ascites / Q000188:drug therapy* / Q000209:etiology; D004322:Drainage / Q000009:adverse effects; D004412:Dysmenorrhea / Q000188:drug therapy / Q000209:etiology; D004715:Endometriosis / Q000150:complications*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy / Q000209:etiology; D009277:Nandrolone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000188:drug therapy* / Q000209:etiology
D007987:Gonadotropin-Releasing Hormone; C023635:dienogest; D009277:Nandrolone
Ascites; Dienogest; Endometriosis