Abdominal Cocoon and Recurrent Haemorrhagic Ascites, Unexpected Findings in Endometriosis: A Case Report and Review of Literature

Introduction: The presentation of endometriosis as massive haemorrhagic ascites and the presence of concurrent encapsulating sclerosing peritonitis is extremely rare in medical literature. This presentation warrants a strong suspicion for endometriosis especially in a nulliparous, reproductive-age woman. Case Report: A 22-year-old woman presenting with nonspecific abdominal discomfort, distension, massive ascites, dysmenorrhea, anaemia, and mild weight loss is reported here. Diagnosis: Based on biopsy results at laparotomy, negative Tuberculosis cultures, a poor response to the anti-tuberculosis therapy, and, finally, an excellent response to combined oral contraceptive pills, endometriosis was confirmed as the diagnosis of exclusion in this case. Interventions and outcomes: The patient received medical treatment for endometriosis and had an excellent response to treatment. Methods: The team conducted a thorough literature review on PubMed/MEDLINE, Cochrane, and Science Direct and shortlisted 13 highly relevant articles for the case report. The patient provided informed written consent for the publication of this case report, with no patient-identifying information included in the article. The figures in the case report have not been published elsewhere, so the authors did not require copyright permission. Conclusion: This is one of the few cases reported in the literature in which endometriosis presented with haemorrhagic ascites and sclerosing peritonitis. Endometriosis should be considered a differential diagnosis in a nulliparous, reproductive-age female who presents with massive recurrent haemorrhagic ascites.