Acute abdomen due to endometriosis as a diagnostic and therapeutic challenge in the treatment of acute myelocytic leukemia

Karthaus M, M Karthaus, Meinolf Karthaus, A Prahst, Prahst A, R. G. Geißler, Geissler RG, R G Geissler, Hertenstein B, B Hertenstein, Bernd Hertenstein, F Degenhardt, Degenhardt F, Ganser A, Arnold Ganser, A Ganser
Annals of hematology · 1997 · vol. 74(1) , pp. 29–31 · doi:10.1007/s002770050251 · PMID:9031612 · W2080383092
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This case report describes a rare instance of acute abdominal symptoms due to endometriosis in a patient with acute myelocytic leukemia, successfully treated with an LHRH agonist and lynestrenol.

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The paper reports a very rare case in a 43-year-old woman with acute myelocytic leukemia (AML-M5) who developed acute abdominal pain four days after induction chemotherapy (idarubicin, ara-C, etoposide), with clinical features resembling acute cholecystitis, subileus, and right upper abdominal pain plus severe diarrhea. Despite regular lynestrenol, probable impaired intestinal absorption was associated with continued menstrual bleeding, and ultrasound showed a tumor in the pouch of Douglas, subcapsular splenic hemorrhage, and a thickened gallbladder wall; endovaginal ultrasound confirmed a cystic adnex tumor, leading to a diagnosis of organ endometriosis. After treatment with a nasal LHRH agonist (nafarelin) alongside lynestrenol, the abdominal pain resolved, and subsequent cycles of chemotherapy using LHRH agonist were reported to prevent further abdominal discomfort and vaginal bleeding, with the caveat that this is a single case report. This paper is centrally about endometriosis — an organ endometriosis presenting as acute abdomen during AML chemotherapy and treated with LHRH agonist therapy to prevent recurrent hemorrhagic symptoms.

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Abstract

Acute abdominal pain is a frequent diagnostic and therapeutic challenge in hematologic patients. We report on the very rare case of organ endometriosis with acute abdominal symptoms in a 43-year-old female patient with AML-M5, starting 4 days after induction chemotherapy with idarubicin, ara-C, and etoposide. The patient presented with an acute abdomen with clinical findings of acute cholecystitis, subileus, and local pain in the right upper abdomen accompanied by severe diarrhea. Probably due to impaired intestinal resorption, menstrual bleeding occurred despite regular administration of lynestrenol. Ultrasound examination of the abdomen disclosed a tumor with poor echoes in the pouch of Douglas, a subcapsular splenic hemorrhage, and a thickened gallbladder wall with surrounding edema. A cystic adnex tumor was confirmed by endovaginal ultrasound. Based on history and the findings on ultrasound, an endometriosis was diagnosed, and the LHRH agonist (nafarelin) was administered nasally in combination with lynestrenol. Following this medication the abdominal pain ceased, supporting the diagnosis of endometriosis. Nasal administration of an LHRH agonist in the following cycles of chemotherapy was effective in preventing further abdominal discomfort and vaginal bleeding. LHRH agonists should be given to patients with known endometriosis before starting myeloablative chemotherapy to prevent painful hemorrhage from endometriosis.
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Abstract Acute abdomial pain is a frequent diagnostic and therapeutic challenge in hematologic patients. We report on the very rare case of organ endometriosis with acute abdominal symptoms in a 43-year-old female patient with AML-M5, starting 4 days after induction chemotherapy with idarubicin, ara-C, and etoposide. The patient presented with an acute abdomen with clinical findings of acute cholecystitis, subileus, and local pain in the right upper abdomen accompanied by severe diarrhea. Probably due to impaired intestinal resorption, menstrual bleeding occurred despite regular administration of lynestrenol. Ultrasound examination of the abdomen disclosed a tumor with poor echoes in the pouch of Douglas, a subcapsular splenic hemorrhage, and a thickened gallbladder wall with surrounding edema. A cystic adnex tumor was confirmed by endovaginal ultrasound. Based on history and the findings on ultrasound, an endometriosis was diagnosed, and the LHRH agonist (nafarelin) was administered nasally in combination with lynestrenol. Following this medication the abdominal pain ceased, supporting the diagnosis of endometriosis. Nasal administration of an LHRH agonist in the following cycles of chemotherapy was effective in preventing further abdominal discomfort and vaginal bleeding. LHRH agonists should be given to patients with known endometriosis before starting myeloablative chemotherapy to prevent painful hemorrhage from endometriosis. Similar content being viewed by others Author information Authors and Affiliations Additional information Received: 20 June 1996 / Accepted: 11 October 1996 Rights and permissions About this article Cite this article Karthaus, M., Prahst, A., Geissler, R. et al. Acute abdomen due to endometriosis as a diagnostic and therapeutic challenge in the treatment of acute myelocytic leukemia. Ann Hematol 74, 29–31 (1997). https://doi.org/10.1007/s002770050251 Issue date: DOI: https://doi.org/10.1007/s002770050251

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Condition tags

endometriosis

MeSH descriptors

Abdomen, Acute Endometriosis Leukemia, Myeloid, Acute Abdomen, Acute Antineoplastic Combined Chemotherapy Protocols Antineoplastic Combined Chemotherapy Protocols Antineoplastic Combined Chemotherapy Protocols Cytarabine Cytarabine Endometriosis Etoposide Etoposide Humans Idarubicin Idarubicin Leukemia, Myeloid, Acute Middle Aged

Citation neighborhood

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