# Endometriosis-associated massive ascites in a young Nigerian lady

## TL;DR

A young Nigerian woman with endometriosis developed severe abdominal fluid, initially mistaken for cancer, but confirmed as endometriosis after surgery and biopsy.

## Contribution

This case highlights the rare but important presentation of endometriosis as massive haemorrhagic ascites in young women.

## Key findings

- Massive haemorrhagic ascites and nodular masses were found in a 31-year-old woman with endometriosis.
- Histopathology confirmed endometriosis, not malignancy, after initial suspicion of ovarian cancer.
- Hormonal suppression with progestogen effectively managed the condition for 15 months without recurrence.

## Abstract

Endometriosis-associated massive haemorrhagic ascites is rare and poses a diagnostic challenge to the gynaecologist due to its resemblance to malignancies, especially ovarian malignancy. We report a 31-year-old nulligravida with progressive abdominal swelling, worsening dysmenorrhea, weight loss and a family history of ovarian tumour. Pelvic ultrasonography and Computed Tomography scans suggested an ovarian mass suspected to be an ovarian malignancy. Exploratory laparotomy revealed massive haemorrhagic ascites (8.6 litre) and multiple nodular masses on the anterior abdominal wall, omentum, bowel and pelvic organs, which were biopsied and confirmed on histopathology to be endometriosis. She had drainage of ascites and hormonal suppression using progestogen (Medroxyprogesterone acetate) with no recurrence in 15 months. Endometriosis should be considered in young, nulligravid women with dysmenorrhea, weight loss and ascites.

None declared