Endometriose com ascite e peritonite encapsulante: uma revisão sistemática com descrição de um caso clínico

Magalhães, Thais Fontes de; Augusto, Kathiane Lustosa; Mota, Livia Ponte; Costa, Arthur Ribeiro da; Puster, Rainardo Antonio; Bezerra, Leonardo Robson Pinheiro Sobreira

doi:10.1055/s-0038-1626700

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Review Article • Rev. Bras. Ginecol. Obstet. 40 (03) • Mar 2018 • https://doi.org/10.1055/s-0038-1626700 copiar

Endometriose com ascite e peritonite encapsulante: uma revisão sistemática com descrição de um caso clínico

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A endometriose pode ter várias apresentações, incluindo ascite e peritonite, que são apresentações incomuns. O aumento da conscientização sobre essa doença podemelhorar a precisão diagnóstica e os resultados das pacientes. Nosso objetivo é fornecer uma revisão sistemática e relatar um caso de endometriose com esta apresentação clínica incomum. O banco de dados PubMed/MEDLINE foi revisado sistematicamente até outubro de 2016. Foram incluídas mulheres comendometriosedemonstrada histologicamente, compresença de ascite clinicamente significativa e/ou abdômen congelado e/ou peritonite encapsulante; foram excluídas aquelas com comorbidades que pudessem provocar confusão. A pesquisa selecionou 37 artigos que descrevem42mulheres, todas emidade reprodutiva. A ascite foi principalmente hemorrágica, recorrente, e não indicada pelos níveis de antígeno associado ao câncer 125 (AC-125). Por sua vez, a dismenorreia, a dispareunia e a infertilidade não foram relatadas de forma consistente. As escolhas e os resultados do tratamento foram diferentes entre os estudos, e são descritos em detalhes. A endometriose deveria ser um diagnóstico diferencial de ascite hemorrágica maciça em mulheres em idade reprodutiva.

Palavras-chave:
endometriose; ascite; peritonite; revisão sistemática; tratamento

Search	Keywords
#1	peritoneal fibrosis OR encapsulating peritoneal sclerosis OR sclerosing encapsulating peritonitis OR abdominal cocoon OR frozen abdomen OR ascites
#2	endometriosis OR endometrioma OR endometriotic OR hemosiderophage
Final search	#1 AND #2

	Treatment for ascites	Outcome
Dun et al, 2016²⁹29 Dun EC, Wong S, Lakhi NA, Nehzat CH. Recurrent massive ascites due to mossy endometriosis. Fertil Steril 2016;106(06):e14. Doi: 10.1016/j.fertnstert.2016.07.1119 https://doi.org/10.1016/j.fertnstert.201...	Leuprolide + oral norethindrone	Ascites persisted
	Laparoscopic evacuation of ascites and excision of endometriosis	No recurrence (6-month follow-up)
Hasdemir et al, 2015⁴⁰40 Hasdemir PS, Ikiz N, Ozcakir HT, Kara E, Guvenal T. Endometriosis associated with relapsing ascites and pleural effusions. J Obstet Gynaecol 2015;35(04):419. Doi: 10.3109/01443615.2014.948823 https://doi.org/10.3109/01443615.2014.94...	Leuprorelin acetate for 6 months	Resolution of symptoms until 2 months after cessation
	Dienogest	Resolution of symptoms (3-month follow-up)
Hinduja et al, 2016⁴²42 Hinduja I, Kapadia K, Udwadia F, Bhilawadikar R, Adhe A, Zaveri K. Unusual presentation of endometriosis with haemorrhagic ascites - A case report. J Obstet Gynaecol 2016;36(01):133-134. Doi: 10.3109/01443615.2015.1030605 https://doi.org/10.3109/01443615.2015.10...	Leuprolide 3.75 mg monthly	Recurrence after 6 months
	TAH + BSO	Ascitic fluid leakage through vaginal suture line (10 days after the operation)
	Short-acting GnRH agonist + oral danazol followed by GnRH only	No recurrence (1-year follow-up)
Setubal et al, 2015²⁴24 Setubal A, Sidiropoulou Z, Soares S, Barbosa C. Endometriosis and ascites: a strategy to achieve pregnancy. J Minim Invasive Gynecol 2015;22(06):1104-1108. Doi: 10.1016/j.jmig.2015.05.013 https://doi.org/10.1016/j.jmig.2015.05.0...	Continuous OCP for 3 months	Ascites persisted
	GnRH agonist, then laparoscopic excision of lesions followed by GnRH agonist	Minimal ascites
	Underwent IVF protocol	Minimal ascites
	OCP	Symptom-free
Appleby et al, 2014²⁸28 Appleby R, Saroya H, Postgate A, Meer Z. A young woman with abdominal distension. BMJ Case Rep 2014;2014:bcr2014203726. Doi: 10.1136/bcr-2014-203726 https://doi.org/10.1136/bcr-2014-203726...	GnRH antagonist	No recurrence (6-month follow-up)
Asano et al, 2014³⁰30 Asano R, Nakazawa T, Hirahara F, Sakakibara H. Dienogest was effective in treating hemorrhagic ascites caused by endometriosis: a case report. J Minim Invasive Gynecol 2014;21(06):1110-1112. Doi: 10.1016/j.jmig.2014.04.014 https://doi.org/10.1016/j.jmig.2014.04.0...	GnRH agonist	Ascites recurred
	Oral dienogest	No recurrence (1-year follow-up)
Bignall et al, 2014²²22 Bignall J, Arambage K, Vimplis S. Endometriosis: a rare and interesting cause of recurrent haemorrhagic ascites. BMJ Case Rep 2014;2014:bcr2013010052. Doi: 10.1136/bcr-2013-010052 https://doi.org/10.1136/bcr-2013-010052...	GnRH agonists	Ascites recurred
	GnRH agonists + tibolone + NSAIDs + pregabalin	Symptoms well-controlled
Cosma et al, 2014⁴¹41 Cosma S, Ceccaroni M, Benedetto C. A pseudoneoplastic finding of deep endometriosis: laparoscopic triple segmental bowel resection. Wideochir Inne Tech Malo Inwazyjne 2014;9(03):463-467. Doi: 10.5114/wiitm.2014.41617 https://doi.org/10.5114/wiitm.2014.41617...	Laparoscopic excision of lesions	Modest recurrence (250 mL) after 42 days
Shabeerali et al, 2012¹¹11 Shabeerali TU, Rajan R, Kuruvilla AP, et al. Hemorrhagic ascites: are we missing endometriosis? Indian J Gastroenterol 2012;31 (04):195-197. Doi: 10.1007/s12664-012-0221-1 https://doi.org/10.1007/s12664-012-0221-...	CASE 1: GnRH analogue	No recurrence (6-month follow-up)
	CASE 2: Subtotal abdominal hysterectomy + BSO	No recurrence (1-year follow-up)
	CASE 3: GnRH analogues for 1 year; then, TAH + BSO	Partial response; then, relatively asymptomatic at 1-year follow-up
Ferrero and Remorgida, 2011³⁶36 Ferrero S, Remorgida V. Endometriosis presenting with hemorrhagic ascites. Arch Gynecol Obstet 2011;283(06):1429-1430. Doi: 10.1007/s00404-010-1796-3 https://doi.org/10.1007/s00404-010-1796-...	Norethindrone acetate (25 mg daily)	No recurrence (1-year follow-up)
Ignacio et al, 2010¹⁸18 Ignacio MM, Joseph N, Hélder F, Mamourou K, Arnaud W. Massive ascites, pleural effusion, and diaphragmatic implants in a patient with endometriosis. Eur J Obstet Gynecol Reprod Biol 2010;149 (01):117-118. Doi: 10.1016/j.ejogrb.2009.10.017 https://doi.org/10.1016/j.ejogrb.2009.10...	GnRH analogue	No recurrence (8-month follow-up)
Lin et al, 2010³⁷37 Lin JN, Lin HL, Huang CK, et al. Endometriosis presenting as bloody ascites and shock. J Emerg Med 2010;38(01):30-32. Doi: 10.1016/j.jemermed.2008.03.031 https://doi.org/10.1016/j.jemermed.2008....	Laparoscopic electrocauterization of lesions	Condition stabilized
Suchetha et al, 2010⁷7 Suchetha S, Rema P, Mathew AP, Sebastian P. Endometriosis with massive hemorrhagic ascites. Indian J Cancer 2010;47(02): 224-225. Doi: 10.4103/0019-509X.63004 https://doi.org/10.4103/0019-509X.63004...	GnRH analogues for 1 year	Good response
Park et al, 2009³⁹39 Park BJ, Kim TE, Kim YW. Massive peritoneal fluid and markedly elevated serum CA125 and CA19-9 levels associated with an ovarian endometrioma. J Obstet Gynaecol Res 2009;35(05): 935-939. Doi: 10.1111/j.1447-0756.2009.01122.x https://doi.org/10.1111/j.1447-0756.2009...	Laparoscopic excision of endometrioma + GnRH agonist for 6 months + tibolone	No recurrence (1-year follow-up)
Sait, 2008³⁸38 Sait KH. Massive ascites as a presentation in a young woman with endometriosis: a case report. Fertil Steril 2008;90(05):2015.e17-2015.e19	Bilateral ovarian cystectomies + GnRH analogue for 6 months followed by OCP	No recurrence (2-year follow-up)
Santos et al, 2007⁶6 Santos VM, Barbosa ER Jr, Lima SH, Porto AS. Abdominal cocoon associated with endometriosis. Singapore Med J 2007;48(09): e240-e242	Laparoscopy + laparotomy	NR. Patient died after 5 months
Palayekar et al, 2007²⁰20 Palayekar M, Jenci J, Carlson JA Jr. Recurrent hemorrhagic ascites: a rare presentation of endometriosis. Obstet Gynecol 2007;110(2 Pt 2):521-522	TAH + BSO	No recurrence (1-year follow-up)
Fortier et al, 2005²³23 Fortier D, Dedecker F, Gabriele M, Graesslin O, Barau G.[Endometriosis with ascites and pleural effusion: a case report]. Gynecol Obstet Fertil 2005;33(7-8):508-510. Doi: 10.1016/j.gyobfe.2005.05.014 https://doi.org/10.1016/j.gyobfe.2005.05...	Ovarian cystectomy + GnRH analogue for 6 months + laparoscopic excision of lesions + oral progesterone for 6 months	Two recurrences
	Ceased treatment and started clomiphene due to pregnancy desire	Ascites recurrence
	GnRH for 2 months	Ascites recurrence
	GnRH for 6 months	Ascites recurrence
Mohd Noor et al, 2004⁸8 Mohd Noor NH, Zaki NM, Kaur G, Naik VR, Zakaria AZ. Abdominal cocoon in association with adenomyosis and leiomyomata of the uterus and endometriotic cyst : unusual presentation. Malays J Med Sci 2004;11(01):81-85	Laparotomy + excision of lesions	No recurrence (4-week follow-up)
Zeppa et al, 2004³⁵35 Zeppa P, Vetrani A, Cozzolino I, Palombini L. Endometrial glands in ascites secondary to endometriosis. Diagn Cytopathol 2004;30 (02):131-132. Doi: 10.1002/dc.10390 https://doi.org/10.1002/dc.10390...	NR	NR
Cheong and Lim, 2003³3 Cheong EC, Lim DT. Massive ascites-an uncommon presentation of endometriosis. Singapore Med J 2003;44(02):98-100	NR	NR
Jeanes et al, 2002³⁴34 Jeanes AC, Murray D, Davidson B, Hamilton M, Watkinson AF. Case report: hepatic and retro-peritoneal endometriosis presenting as obstructive jaundice with ascites: a case report and review of the literature. Clin Radiol 2002;57(03):226-229. Doi: 10.1053/crad.2001.0667 https://doi.org/10.1053/crad.2001.0667...	Double hysterectomy + left oophorectomy followed by estradiol for 6 months followed by goserelin	No recurrence (3-year follow-up)
Moffatt and Mitchell, 2002¹⁹19 Moffatt SD, Mitchell JD. Massive pleural endometriosis. Eur J Cardiothorac Surg 2002;22(02):321-323. Doi: 10.1016/S10107940(02)00277-4 https://doi.org/10.1016/S10107940(02)002...	Leuprolide + premarin	Recurrence after 4 weeks
	TAH + BSO + leuprolide	No recurrence (9-month follow-up)
Bhojawala et al, 2000¹⁷17 Bhojawala J, Heller DS, Cracchiolo B, Sama J. Endometriosis presenting as bloody pleural effusion and ascites-report of a case and review of the literature. Arch Gynecol Obstet 2000; 264(01):39-41. Doi: 10.1007/PL00007484 https://doi.org/10.1007/PL00007484...	TAH + RSO	No recurrence (6-week follow-up)
Samora-Mata and Feste, 1999²⁵25 Samora-Mata J, Feste JR. Endometriosis ascites: a case report. JSLS 1999;3(03):229-231	TAH + RSO	NR
Myneyyirci-Delale et al, 1998¹²12 Muneyyirci-Delale O, Neil G, Serur E, Gordon D, Maiman M, Sedlis A. Endometriosis with massive ascites. Gynecol Oncol 1998;69 (01):42-46. Doi: 10.1006/gyno.1998.4953 https://doi.org/10.1006/gyno.1998.4953...	Laparoscopic excision of lesions followed by GnRH agonist for 6 months; then, excision of new ovarian cyst + danazol daily for 6 months followed by norethindrone acetate	Recurrence after 1 year; then, no recurrence (3-year follow-up)
	Laparotomy + monthly depo provera injections; then, TAH + BSO	Recurrence after 3 years; then, no recurrence (6-month follow-up)
	Appendectomy and left ovarian wedge resection + lupron	No recurrence
	Lysis of adhesions + LSO followed by lupron followed by norethindrone acetate	NR
Frigerio et al, 1997⁵5 Frigerio L, Taccagni GL, Mariani A, Mangili G, Ferrari A. Idiopathic sclerosing peritonitis associated with florid mesothelial hyperplasia, ovarian fibromatosis, and endometriosis: a new disorder of abdominal mass. Am J Obstet Gynecol 1997;176(03):721-722. Doi: 10.1016/S0002-9378(97)70581-7 https://doi.org/10.1016/S0002-9378(97)70...	TAH + BSO + appendectomy + omentectomy	No recurrence (3-year follow-up)
Mejia et al, 1997¹⁶16 Mejia EM, Alvarez OA, Lee M. Endometriosis with massive bloody ascites. J Am Board Fam Pract 1997;10(01):59-61	Laparotomy	No recurrence (15-month follow-up)
Flanagan and Barnes, 1996²¹21 Flanagan KL, Barnes NC. Pleural fluid accumulation due to intraabdominal endometriosis: a case report and review of the literature.Thorax1996;51(10):1062-1063.Doi:10.1136/thx.51.10.1062 https://doi.org/10.1136/thx.51.10.1062...	Laparotomy + GnRH agonist for 6 months	Recurrence (twice in 1 year)
	Prednisolone 30 mg daily	Recurrence
	Leuprorelin for 5 months	Recurrence
Myers et al, 1995³³33 Myers TJ, Arena B, Granai CO. Pelvic endometriosis mimicking advanced ovarian cancer: presentation with pleural effusion, ascites, and elevated serum CA 125 level. Am J Obstet Gynecol 1995;173(3 Pt 1):966-967	TAH + BSO + lysis of adhesions	No recurrence (8-month follow-up)
Jose et al, 1994³²32 Jose R, George SS, Seshadri L. Massive ascites associated with endometriosis. Int J Gynaecol Obstet 1994;44(03):287-288. Doi: 10.1016/0020-7292(94)90185-6 https://doi.org/10.1016/0020-7292(94)901...	LSO	Recurrence after 1 year
	Laparotomy + danazol	NR
Schlueter an McClennan, 1994¹³13 Schlueter FJ, McClennan BL. Massive ascites and pleural effusions associated with endometriosis. Abdom Imaging 1994;19(05): 475-476	Leuprolide acetate monthly	No recurrence (3-month follow-up)
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	Depot lupron for 3 months	Some ascites
	TAH + BSO	Recurrence after 3 months
	Tenckhoff catheter placed for 2 weeks	No recurrence (9-month follow-up)
Chichareon and Wattanakitkrailert, 1988³¹31 Chichareon SB, Wattanakitkrailert S. Endometriosis with ascites. Acta Obstet Gynecol Scand 1988;67(02):187-188. Doi: 10.3109/00016348809004198 https://doi.org/10.3109/0001634880900419...	TAH + BSO	No recurrence (6-month follow-up)
Olubuyide et al, 1988²⁷27 Olubuyide IO, Adebajo AO, Adeleye JA, Solanke TF. Massive ascites associated with endometriosis in a Nigerian African. Int J Gynaecol Obstet 1988;27(03):439-441. Doi: 10.1016/0020-7292(88) 90127-0 https://doi.org/10.1016/0020-7292(88)...	Oral norethisterone	No recurrence (1-year follow-up)
Naraynsingh et al, 1985²⁶26 Naraynsingh V, Raju GC, Ratan P, Wong J. Massive ascites due to omental endometriosis. Postgrad Med J 1985;61(716):539-540. Doi: 10.1136/pgmj.61.716.53 https://doi.org/10.1136/pgmj.61.716.53...	Depo provera for 6 months	No recurrence (4-year follow-up)
Cantor et al, 1979¹⁴14 Cantor JO, Fenoglio CM, Richart RM. A case ofextensive abdominal endometriosis. Am J Obstet Gynecol 1979;134(07):846-847. Doi: 10.1016/0002-9378(79)90958-X https://doi.org/10.1016/0002-9378(79)909...	NR	NR

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[1] Address for correspondence Thais Fontes de Magalhães, MD, Departmento de Ginecologia, Universidade Federal do Ceara, Rua Alexandre Barauna 949, Fortaleza, CE, 60430-160, Brazil (e-mail: thaisfdemagalhaes@gmail.com).