Treatment and fertility outcomes of moss-like endometriosis with hemorrhagic ascites: A case report.

RATIONALE: 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.

PATIENT CONCERNS: 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.

DIAGNOSES: 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.

INTERVENTIONS: 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.

OUTCOMES: 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.

LESSONS: 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.