Xu Feng, Gao Yimeng, He Fengxi, Zhao Miao, Li Aihua
School of Clinical Medicine, Shandong Second Medical University, Weifang, China.
Department of Gynecology and Obstetrics, Liaocheng People's Hospital, Liaocheng, China.
Medicine (Baltimore). 2025 Mar 21;104(12):e41872. doi: 10.1097/MD.0000000000041872.
Endometrial tissue in the greater omentum with a large amount of hemorrhagic ascites is relatively uncommon. Endometriosis is similar to ovarian malignancy in cases of hemorrhagic ascites. Hysterectomy and bilateral oophorectomy are the only effective and clear treatments, and their indications are limited by patient age and fertility. Conservative medical treatment is a viable option.
A 28-year-old female came to our hospital for treatment because of the discovery of a pelvic mass for 10 months. After admission, the patient underwent surgical treatment and was discharged within 1 week. She received medical treatment for 3 years after discharge. After medication withdrawal, the patient became pregnant and gave birth to a child without recurrence during the follow-up.
Initial diagnosis on first admission were "'Pelvic inflammatory mass?' and 'endometriosis?'." After 10 months, the patient was readmitted to the hospital because of gradual enlargement of the mass, and was diagnosed with endometriosis.
The patient was treated with anti-infective rehydration therapy for the first time, and the patient was surgically treated for the second time, followed by gonadotropin-releasing hormone agonist (GnRH-α) and dienogest (DNG) treatment after surgery.
After 6 cycles of GnRH-α treatment and 3 years of DNG treatment, a son was successfully born after discontinuation of the medication, and so far, there has been no recurrence or adverse reactions during the follow-up period.
Ascites is a rare manifestation of endometriosis and its diagnosis is difficult. Laparoscopy or exploratory laparotomy is required to confirm this diagnosis. Cyclic dysmenorrhea and abnormal menstruation warrant vigilance and should be investigated carefully. Hysterectomy and bilateral oophorectomy should be avoided as much as possible in patients with fertility needs and age adaptation, and symptoms can be successfully resolved with medical therapy.
大网膜内存在子宫内膜组织并伴有大量血性腹水的情况相对少见。在出现血性腹水的病例中，子宫内膜异位症与卵巢恶性肿瘤相似。子宫切除术和双侧卵巢切除术是仅有的有效且明确的治疗方法，但其适应证受患者年龄和生育需求限制。保守药物治疗是一种可行的选择。
一名28岁女性因发现盆腔包块10个月前来我院就诊。入院后，患者接受了手术治疗，并在1周内出院。出院后接受了3年药物治疗。停药后，患者怀孕并产下一子，随访期间未复发。
首次入院时初步诊断为“盆腔炎性包块？”和“子宫内膜异位症？”。10个月后，患者因包块逐渐增大再次入院，被诊断为子宫内膜异位症。
患者首次接受抗感染补液治疗，第二次接受手术治疗，术后接受促性腺激素释放激素激动剂（GnRH-α）和地诺孕素（DNG）治疗。
经过6个周期的GnRH-α治疗和3年的DNG治疗，停药后成功产下一名男婴，迄今为止，随访期间未出现复发或不良反应。
腹水是子宫内膜异位症的罕见表现，诊断困难。需要通过腹腔镜检查或剖腹探查来确诊。周期性痛经和月经异常应引起警惕，需仔细排查。对于有生育需求且年龄合适的患者，应尽可能避免子宫切除术和双侧卵巢切除术，药物治疗可成功缓解症状。
