Shabeerali T U, Rajan Ramesh, Kuruvilla A P, Noronha Selwyn, Krishnadas Devadas, Shenoy K T, Manjula M, Shenoy Sheela, Raji N Laila
Department of Surgical Gastroenterology, Medical College, Trivandrum, 695 011 Kerala, India.
Indian J Gastroenterol. 2012 Jul;31(4):195-7. doi: 10.1007/s12664-012-0221-1. Epub 2012 Jul 5.
Peritoneal tuberculosis, carcinomatosis and pancreatic ascites are often considered as differential diagnosis of hemorrhagic ascites. Endometriosis can rarely present as hemorrhagic ascites and closely mimic these conditions. When this occurs without common clinical features of endometriosis, it can create a diagnostic challenge to the treating physician. We present three patients with endometriosis who presented with hemorrhagic ascites; two of them did not have gynecological symptoms or significant pelvic disease. These patients were evaluated several times in many centers and even received multiple courses of anti-tuberculous treatment. The diagnosis was made by histologic examination of parietal peritoneum obtained by laparoscopy or laparotomy. The diagnosis was missed possibly because of the atypical presentation, lack of clinical suspicion and incomplete assessment. In conclusion, this potentially treatable condition should be considered as a differential diagnosis for hemorrhagic ascites in a premenopausal woman.
腹膜结核、癌性腹膜炎和胰源性腹水常被视为血性腹水的鉴别诊断。子宫内膜异位症很少表现为血性腹水，且与这些病症极为相似。当出现这种情况且无子宫内膜异位症的常见临床特征时，会给主治医生带来诊断挑战。我们报告了3例表现为血性腹水的子宫内膜异位症患者；其中2例没有妇科症状或明显的盆腔疾病。这些患者在多个中心接受了多次评估，甚至接受了多疗程的抗结核治疗。诊断通过腹腔镜检查或剖腹手术获取的壁层腹膜组织学检查得以明确。诊断失误可能是由于表现不典型、缺乏临床怀疑以及评估不全面。总之，这种潜在可治的病症应被视为绝经前女性血性腹水的鉴别诊断之一。
