Ascites due to endometriosis

Ascites is a rare but important complication of endometriosis because it mimics ovarian cancer. Most cases occur in nulliparous young black women and present with massive ascites. Treatment is effected by ablation of ovarian function by surgery, radiotherapy, or suppression of endometriosis by endocrine therapy. The pathogenesis is unknown. In this paper, we present a case report and review of the other 19 cases in the literature. Because of the age of most of these women, endocrine therapy is preferred rather than castration. The majority of symptoms and signs of endometriosis are well known, including pelvic pain, dysmenorrhea, dyspareunia, infertility, and pelvic tenderness with or without masses. However, it is seldom appreciated that the disease can be a cause of, and can present with ascites, often massive and recurrent. It is important for gynecologists and oncologists to be aware of this entity because the presence of ascites with abdominal and/or pelvic masses and weight loss immediately suggests the diagnosis of malignancy, and the possibility of endometriosis is rarely considered. We are reporting a case of endometriosis causing massive and recurrent ascites, along with a review of the literature and a discussion of the epidemiology, pathogenesis, and management of this disorder.