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Endometriosis presenting as recurrent massive haemorrhagic ascites
Mark Trevor Verryn1, Alistair Guy Balleine Broadhurst2, Christine Els3
1Department of Internal Medicine, Khayelitsha Hospital, Cape Town, South Africa.
BMJ Case Reports
|August 13, 2026
Summary
Haemorrhagic ascites (HA) is rare and challenging to diagnose when common causes are absent. This case highlights endometriosis as an uncommon cause of recurrent HA, emphasizing diagnostic considerations for rare conditions.
Area of Science:
- Gastroenterology and Hepatology
- Gynecology and Obstetrics
- Surgical Pathology
Background:
- Haemorrhagic ascites (HA) is an uncommon condition.
- Common causes include cirrhosis, malignancy, and iatrogenic factors.
- Diagnosis can be challenging when typical etiologies are excluded.
Purpose of the Study:
- To present a case of recurrent massive HA.
- To illustrate diagnostic challenges in HA.
- To highlight rare causes of HA, specifically endometriosis.
Main Methods:
- Extensive work-up for common causes of HA was performed and yielded negative results.
- Laparoscopic surgery was conducted.
- Histopathological examination of laparoscopically obtained tissue confirmed the diagnosis.
Main Results:
- A diagnosis of endometriosis was confirmed via laparoscopic tissue analysis.
- This rare cause explained the patient's recurrent massive HA.
- The case underscores diagnostic pitfalls associated with HA.
Conclusions:
- Endometriosis should be considered in the differential diagnosis of HA, particularly in women.
- This case highlights the importance of considering rarer etiologies when common causes are ruled out.
- Comprehensive diagnostic approaches are crucial for managing challenging HA cases.
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