RECURRENT ASCITES : A Rare Presentation of Endometriosis

RECURRENT ASCITES : A Rare Presentation of Endometriosis
Manjiri S Mehta*, N A Dastur**, N K Sherier***
*Lecturer; **Hon. Prof. and Unit Head; ***Hon. Clinical Assistant; N Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai.

Mrs. F., 38 year old married since 11 years, infertile, presented with dysmenorrhoea, dyspareunia and abdominal distension.

She had regular menstrual cycles with adequate coital frequency.

She had undergone laparoscopies twice 3 and 4 years ago for treatment of infertility and recurrent ascites. The fluid collected at one of them was tuberculous like but could not be proved on cytology and microscopy. She had received anti-tuberculous treatment for the same.

HSG done later showed normal uterine cavity with left sided hydrosalpinx with spill and right sided loculated spill.

The routine haematological investigations and semen analysis were normal. USG revealed (N) uterus with endometrial thickness of 8 mm.

(Rt) ovary - (N)
(Lt) ovary with haemorrhagic cyst measuring 2.5 x 2.5-cm. S/o endometriotic cyst and presence of-loculated ascites with thin septations.

On examining her the vital parameters were stable. Scars of previous scopies were seen to be healthy. Abdomen was distended with fullness in flanks. Speculum and bimanual examination did not reveal any abnormality.

At the time of surgery around 1.5 lit of clean ascitic fluid was drained on inserting the Verre’s needle.

Laparoscope was then introduced by infraumbilical incision. It showed presence of extensive endometriosis like implants scattered all over the peritoneal cavity. There were few flimsy adhesion in the pelvis.

Pelvic adhesiolysis was performed and biopsy was taken from the peritoneal implants.

The (Rt) tube and ovary was brought back to the normal anatomical relation.

Fig. 1 Fig. 2

The fluid collected between the leaves of broad ligaments on either side was also aspirated.
The left sided tubo-ovarian relation could not be brought back to normal.
At the end there was free spill of dye from the right tube and delayed spill from the left.

The examination of ascitic fluid revealed it to be transudative in nature and the biopsy of the implant revealed to be an active endometriotic lesion.

The postoperative course was uneventful and patient was started on Dannazol. At the end of 1 month she was symptomatically better with no reformation of ascites.

To Section TOC