Hemoperitoneum due to deep endometriosis in a patient on peritoneal dialysis with a good response to progestin

In: Brazilian Journal of Case Reports · 2023 · vol. 4(3) , pp. 49–52 · doi:10.52600/2763-583x.bjcr.2024.4.3.49-52 · W4388284133
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This paper describes a case of hemoperitoneum in a peritoneal dialysis patient with deep endometriosis that responded well to progestin therapy.

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This paper reports a single clinical case of hemoperitoneum in a patient undergoing peritoneal dialysis, describing deep endometriosis as the cause despite a history of hysterectomy. The authors frame hemoperitoneum in peritoneal dialysis by noting that gynecologic etiologies are most common in adult women, often related to the menstrual cycle, and that endometriosis can bleed from peritoneal implants or detached endometrial tissue. In this case, the patient had an excellent response to oral progestin. This paper is centrally about endometriosis — a case report linking deep endometriosis to hemoperitoneum in a peritoneal dialysis patient with treatment response to progestin.

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Abstract

Hemoperitoneum is common in patients undergoing peritoneal dialysis. Its varied causes include catheter-related complications, obstetric and gynecological etiologies, coagulopathies, and vascular, infectious, and intra-abdominal pathologies. A gynecological etiology, whether pathological or physiological, is the most common cause of hemoperitoneum in adult women undergoing peritoneal dialysis, with more than one-third of cases related to the menstrual cycle. Endometriosis can also cause hemoperitoneum, and the bleeding may originate from endometrial tissue implanted in the peritoneal cavity or that detaches from the intrauterine endometrium during the menstrual period. We report a case of hemoperitoneum in a patient with deep endometriosis and previous hysterectomy who had an excellent response to oral progestin.
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Abstract

Hemoperitoneum is common in patients undergoing peritoneal dialysis. Its varied causes include catheter-related complications, obstetric and gynecological etiologies, coagulopathies, and vascular, infectious, and intra-abdominal pathologies. A gynecological etiology, whether pathological or physiological, is the most common cause of hemoperitoneum in adult women undergoing peritoneal dialysis, with more than one-third of cases related to the menstrual cycle. Endometriosis can also cause hemoperitoneum, and the bleeding may originate from endometrial tissue implanted in the peritoneal cavity or that detaches from the intrauterine endometrium during the menstrual period. We report a case of hemoperitoneum in a patient with deep endometriosis and previous hysterectomy who had an excellent response to oral progestin. Article Details This work is licensed under a Creative Commons Attribution 4.0 International License. Authors retain the copyright of their articles and grant the journal the right of first publication under the Creative Commons Attribution (CC BY) license, which allows others to share and adapt the work with proper attribution.

References

Valenzuela MP, Ponz E, Ocaña JCM, Blasco C, Marquina D, Mané N, Garcia MG. Prognostic significance of hemoperitoneum in peritoneal dialysis. Nephrology. 2008;1:73–6. Kohn OF, Culbertson S, Becker YT. Hemoperitoneum in a peritoneal dialysis patient: ruptured ectopic pregnancy. Perit Dial Int. 2018;38:455–6. doi: 10.3747/pdi.2018.00066. PMID: 30413637. Lew SQ. Hemoperitoneum: bloody peritoneal dialysate in ESRD patients receiving peritoneal dialysis. Perit Dial Int. 2007;27:226–33. Yaseen O, El Nekidy WS, Ibrahim AR, Jasey BB, Guignard M, Kadri A. Cyclic pseudoperitonitis secondary to endometriosis in a peritoneal dialysis patient. Perit Dial Int. 2012;32:662–4. Harnett JD, Ch B, Gill D, Corbett L, Parfrey PS. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis. Ann Intern Med. 1987;207:341–3. Dimitriadis CA, Bargman JM. Gynecologic issues in peritoneal dialysis. Adv Perit Dial. 2011;27:101–5. Sussman SQ, Arenas CL, Celis FA. Hemoperitoneum in peritoneal dialysis, a red flag? Case report. Rev Colomb Nefrol. 2015;2:70–5. Greenberg A, Bernardini J, Piraino BM, Johnston JR, Perlmutter JA, Report C. Hemoperitoneum complicating chronic peri-toneal dialysis: single center experience and literature review. Am J Kidney Dis. 1992;19:252–6. Fraley DS, Johnston JR, Bruns FJ, Adler S, Segel DP. Rupture of ovarian cyst: massive hemoperitoneum in continuous am-bulatory peritoneal dialysis patients: diagnosis and treatment. Am J Kidney Dis. 1988;12:69–71. doi: 10.1016/S0272-6386(88)80075-1. França PRC, Lontra ACP, Fernandes PD. Endometriosis: A Disease with Few Direct Treatment Options. Molecules. 2022;27(13), 4034.

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endometriosis

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