{"paper_id":"8e72ef8c-4a62-4c32-86c2-1b8df129ae9b","body_text":"Abstract\nBackground\nThe present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion.\nMethods\nTo conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired.\nResults\nSince the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites.\nConclusion\nEndometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.\nSimilar content being viewed by others\nReferences\nRochling FA, Zetterman RK (2009) Management of ascites. Drugs 69(13):1739–1760\nWitz CA (2002) Pathogenesis of endometriosis. Gynecol Obstet Invest 53(suppl 1):52–62\nHoward FM (2009) Endometriosis and mechanisms of pelvic pain. J Minim Invasive Gynecol 16(5):540–550\nDaniels J, Gray R, Hills RK (2009) Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 302:955–961\nGivens V, Mitchell GE, Harraway-Smith C, Reddy A, Maness DL (2009) Diagnosis and management of adnexal masses. Am Fam Physician 80(8):815–820\nCheng MH, Yen MS, Chao KC, Sheu BC, Wang PH (2008) Differential diagnosis of gynecologic organ-related diseases in women presenting with ascites. Taiwan J Obstet Gynecol 47(4):384–390\nGostout BS, Brewer MA (2006) Guidelines for the referral of the patient with adnexal mass. Clin Obstet Gynecol 49(3):448–458\nBrews A (1954) Endometriosis including endometriosis of the diaphragm and Meigs’ syndrome. Proc Roy Soc Med 47:461\nCharles D (1957) Endometriosis and hemorrhagic pleural effusion. Obstet Gynecol 10:309–312\nBoles RS, Hodes RJ (1958) Endometriosis of the large and small intestine. Gastroenterology 34:367–380\nRipstein CB, Rohman M, Wallach JB (1959) Endometriosis involving the pleura. J Thorac Cardiovasc Surg 37:464–471\nBernstein JS, Perlow V, Brenner JJ (1961) Massive ascites due to endometriosis. Am J Dig Dis 6:1–7\nIrani S, Atkinson L, Cabaniss S, Danovitch SH (1976) Pleuroperitoneal endometriosis. Obstet Gynecol 47:72s–74s\nCantor JO, Fenoglio CM, Richart RM (1979) A case of extensive abdominal endometriosis. Am J Obstet Gynecol 134:846–847\nChervenak F, Greenlee RM, Lewenstein L, Tovell HMM (1981) Massive ascites associated with endometriosis. Obstet Gynecol 57:379–381\nGaulier A, Jouret-Mourin A, Marsan C (1983) Peritoneal endometriosis: a report of a case with cytologic, cytochemical and histopathologic study. Acta Cytol 27:446–449\nJenks JE, Artman LE, Hoskins WJ, Miremadi AK (1984) Endometriosis with ascites. Obstet Gynecol 63:75s–77s\nHalme J, Chafe W, Currie JL (1985) Endometriosis with massive ascites. Obstet Gynecol 65:591–592\nIwasaka T, Okuma Y, Yoshimura T, Kidera Y, Sugimori H (1985) Endometriosis associated with ascites. Obstet Gynecol 66:72s–75s\nNaraysingh V, Raju GC, Ratan P, Wong J (1985) Massive ascites due to omental endometriosis. Postgrad Med J 61:539–540\nChichareon SB, Wattanakitkrailert S (1988) Endometriosis with ascites. Acta Obstet Gynecol Scand 67:187–188\nFeigin RD, Glikson M, Gur H, Galun E, Younis JF, Beyth Y (1988) Induction of ovulation causing recurrent bloody ascites in a woman with endometriosis. Am J Obstet Gynecol 159:1161–1162\nOlubuyide IO, Adebajo AO, Adeleye JA, Solanke TF (1988) Massive ascites associated with endometriosis in a Nigerian-African. Int J Gynaecol Obstet 27:439–441\nMeinen K, Crusius M, Schulz U (1989) Turner syndrome with peritoneal endometriosis and ascites—therapeutic effects of buserelin therapy. Arch Gynecol Obstet 245(1–4):943–945\nTaub WH, Rosado S, Kalaycioglu M, Booher D, Barnes DS (1989) Hemorrhagic ascites secondary to endometriosis. J Clin Gastroenterol 11:458–460\nHattori S, Tamakoshi K, Oguchi H, Kodama H (1990) A case of endometriosis with massive ascites. Nippon Sanka Fujinka Gakkai Zasshi 42(3):291–294\nTsvelev IuV, Lishchuk VD, Kolosov AE (1990) Ascites as a manifestation of generalized endometriosis. Vestn Khir Im I I Grek 145(7):48–50\nWilliams RS, Wagaman R (1991) Endometriosis associated with massive ascites and absence of pelvic peritoneum. Am J Obstet Gynecol 164:45–46\nYu J, Grimes D (1991) Ascites and pleural effusion associated with endometriosis. Obstet Gynecol 78:533–534\nChen FF, Chow NH, Chou CY, Lin MF (1992) Hemorrhagic ascites associated with endometriosis: a rare clinical presentation. J Gynecol Surg 8:43–47\nCharran D, Roopnarinesingh S (1993) Hemothorax and ascites associated with endometriosis. West Indian Med J 42:40–41\nLondon S, Parmley T (1993) Endometriosis and ascites. South Med J 86:1173–1175\nJose R, George SS, Seshadri L (1994) Massive ascites associated with endometriosis. Int J Gynaecol Obstet 44(3):287–288\nSchlueter FJ, McClennan BL (1994) Massive ascites and pleural effusions associated with endometriosis. Abdom Imaging 19:475–476\nEl-Newihi HM, Antaki JP, Rajan S, Reynolds TB (1995) Large bloody ascites in association with pelvic endometriosis: case report and literature review. Am J Gastroenterol 90(4):632–634\nMyers TJ, Arena B, Granai CO (1995) Pelvic endometriosis mimicking advanced ovarian cancer: presentation with pleural effusion, ascites, and elevated serum CA125 level. Am J Obstet Gynecol 173:966–967\nShek Y, De-Lia JE, Patillo RA (1995) Endometriosis with pleural effusion and ascites. Report of a case treated with nafarelin acetate. J Reprod Med 40(7):540–542\nSpitzer M, Benjamin F (1995) Ascites due to endometriosis. Obstet Gynecol Surv 50(8):628–631\nFlanagan KL, Barnes NC (1996) Pleural fluid accumulation due to intra-abdominal endometriosis: a case report and review of the literature. Thorax 51:1062–1063\nMejia EM, Alvarez OA, Lee M (1997) Endometriosis with massive bloody ascites. J Am Board Fam Pract 10(1):59–61\nMuneyyirci-Delale O, Neil G, Seur E, Gordon D, Maiman M, Sedlis A (1998) Endometriosis with massive ascites. Gynecol Oncol 69:42–46\nFletcher H, McFarlane M, Shirley SE, Clarke WF, Lyon K (1999) Massive ascites secondary to severe endometriosis. West Indian Med J 48:158–159\nEl Khalil T, Mourad FH, Barada K, Uthman S (1999) Massive hemorrhagic ascites secondary to endometriosis. J Clin Gastroenterol 29:344–345\nSamora-Mata J, Feste JR (1999) Endometriosis ascites: a case report. JSLS 3:229–231\nBhojawala J, Heller DS, Cracchiolo B, Sama J (2000) Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecol Obstet 264:39–41\nDias CC, Andrade JM, Ferriani RA, Villanova MG, Meirelles R (2000) Hemorrhagic ascites associated with endometriosis. A case report. J Reprod Med 45(8):688–690\nJeanes AC, Murray D, Davidson B, Hamilton M, Watkinson AF (2002) Case report: hepatic and retroperitoneal endometriosis presenting as obstructive jaundice with ascites: a case report and review of the literature. Clin Radiol 57:226–229\nMoffatt SD, Mitchell JD (2002) Case report: massive pleural endometriosis. Eur J Cardiothorac Surg 22:321–323\nCheong EC, Lim DT (2003) Massive ascites-an uncommon presentation of endometriosis. Singap Med J 44:98–100\nFrancis M, Badero OO, Borowsky M, Lee YC, Abulafia O (2003) Pericardial effusion, right-sided pleural effusion and ascites associated with stage IV endometriosis. A case report. J Reprod Med 48(6):463–465\nZeppa P, Vetrani A, Cozzolino I, Palombini L (2004) Endometrial glands in ascites secondary to endometriosis. Diagn Cytopathol 30(2):131–132\nDonnez J, Jadoul P (2005) Ascites and pelvic masses: an unusual case of endometriosis. Fertil Steril 83:195–197\nEkoukou D, Guilherme R, Desligneres S, Rotten D (2005) Endometriosis with massive hemorrhagic ascites: a case report and review of the literature (French). J Gynecol Obstet Biol Reprod 34(4):351–359\nFortier D, Dedecker F, Gabriele M, Graesslin O, Barau G (2005) Endometriosis with ascites and pleural effusion: a case report (French). Gynécol Obstét Fertil 33:508–510\nGoumenou A, Matalliotakis I, Mahutte N, Koumantakis E (2006) Endometriosis mimicking advanced ovarian cancer. Fertil Steril 86:219.e23–219.e25\nMwenechanya S, Beck I (2007) Unusual presentation of endometriosis with massive ascites and recurrent pleural effusion: a case report and review of the literature. Gynecol Surg 4:57–59\nPalayekar M, Jenci J, Carlson JA Jr (2007) Recurrent hemorrhagic ascites: a rare presentation of endometriosis. Obstet Gynecol 110(2 Pt 2):521–522\nSait KH (2008) Massive ascites as a presentation in a young woman with endometriosis: a case report. Fertil Steril 90(5):2015.e17–2015.e19\nSakpal SV, Patel C, Chamberlain RS (2009) Near lethal endometriosis and a massive (64 kg) endometrioma: case report and review of the literature. Clin Exp Obstet Gynecol 36(1):49–52\nHaeri S, Cosin JA (2009) Endometriosis mimicking ovarian cancer in the setting of acquired immune deficiency syndrome. Obstet Gynecol 114(2 Pt 2):425–426\nPark BJ, Kim TE, Kim YW (2009) Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma. J Obstet Gynecol Res 35(5):935–939\nIgnacio MM, Mamourou K, Arnaud W (2010) Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol 149:117–123\nLin JN, Lin HL, Huang CK, Lai CH, Chung HC, Liang SH, Lin HH (2010) Endometriosis presenting as bloody ascites and shock. J Emerg Med 38(1):30–32\nSuchetha S, Rema P, Mathew AP, Sebastian P (2010) Endometriosis with massive hemorrhagic ascites. Indian J Cancer 47(2):224–225\nAcknowledgments\nWe acknowledge our colleagues for their help in the translation of non-English papers.\nConflict of interest\nNone.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nGungor, T., Kanat-Pektas, M., Ozat, M. et al. A systematic review: endometriosis presenting with ascites. Arch Gynecol Obstet 283, 513–518 (2011). https://doi.org/10.1007/s00404-010-1664-1\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-010-1664-1","source_license":"CC0","license_restricted":false}