Radical surgery for pseudo-ovarian malignancy: a case report of bowel endometriosis with massive ascites

Endometriosis is a disturbing condition affecting about 10% of all reproductive aged women. The most severe form of endometriosis is deeply infiltrative endometriosis (DIE). Bowel is commonly affected in DIE. Treatment options of bowel endometriosis include surgery and medication, depending on many factors such as age, the severity of symptoms and desire for pregnancy. At present, the individualized comprehensive management of bowel endometriosis is still under exploration. Here we report an uncommon case of bowel endometriosis treated by radical surgery and postoperative high-dose progestin to enrich the clinical experience. A 37-year-old woman was admitted to our hospital for suspected ovarian malignancy in the presence of pelvic mass, massive ascites and elevated CA-125. A laparoscopic radical surgery was performed, and she was diagnosed with bowel endometriosis. Considering the patient's high recurrence risk indicated by bowel endometriosis, massive ascites, severe adhesions, and dysmenorrhea, six-course gonadotropin-releasing hormone agonists therapy followed by high-dose progestin (two levonorgestrel intrauterine systems and subdermal implants) was administrated postoperatively to improve symptoms and prevent recurrence. No recurrence in bowels was observed by November 2021 (53 months). Both patient's desire and condition should be considered in the management of symptomatic bowel endometriosis. Optimal surgical removal is of great significance and individualized hormonal therapy may provide an additional component.