Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 6206-6212
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6206
Novel triple therapy for hemorrhagic ascites caused by endometriosis: A case report
Xue Han, Shi-Tai Zhang
Xue Han, Shi-Tai Zhang, Gynecology Department, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Han X and Zhang ST contributed equally to this work, analyzed the case, wrote the manuscript, and read and approved the final manuscript.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement:  The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shi-Tai Zhang, MD, PhD, Attending Doctor, Lecturer, Gynecology Department, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, Liaoning Province, China. zhangshitai@126.com
Received: August 10, 2020
Peer-review started: August 10, 2020
First decision: August 21, 2020
Revised: September 13, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: December 6, 2020
Abstract
BACKGROUND

Massive hemorrhagic ascites caused by endometriosis is exceedingly rare, and the treatment strategy remains controversial. Here, we report a case of endometriosis with massive hemorrhagic ascites treated with a novel triple therapy including conservative surgery, gonadotropin-releasing hormone agonist, and then dienogest.

CASE SUMMARY

A 28-year-old nulliparous patient was admitted to Shengjing Hospital of China Medical University, and exploratory laparoscopy was performed. A total of 9500 mL of brown ascites was aspirated from the pelvic cavity, the bilateral ovaries strongly adhered to the posterior of the uterus and were fixed to the pelvic floor, and endometriotic cysts were not observed in either ovary. The pelvic and abdominal peritonea were covered with patchy red, white, and brown endometriotic lesions and defects. Partial surgical resection of endometriotic lesions on the peritoneum was performed while we simultaneously collected multiple peritoneal biopsies. The final pathological diagnosis was endometriosis coupled with hemorrhagic necrotic tissue.

CONCLUSION

Postoperative injection of gonadotropin-releasing hormone agonist was provided three times, followed by dienogest administration, and we will continue to follow up with this ongoing treatment.

Keywords: Endometriosis, Hemorrhagic ascites, Novel triple therapy, Dienogest, Recurrence, Case report

Core Tip: We for the first time report a case of endometriosis-related massive ascites treated with a novel triple therapy including conservative surgery, gonadotropin-releasing hormone agonist, and dienogest, which offers a new possibility to treat the disease.