Background: Endometriosis is rarely a cause of recurrent hemorrhagic ascites. This report draws attention to this uncommon condition, which could present a diagnostic dilemma.
Case: A young African-American woman who had experienced recurrent hemorrhagic ascites for more than 2 years underwent laparotomy and was found to have extensive pelvic endometriosis. After a hysterectomy and bilateral salpingo-oophorectomy, her ascites resolved.
Conclusion: Endometriosis should be considered in the differential diagnosis of recurrent hemorrhagic ascites in premenopausal women. The diagnosis always requires operative assessment and histologic confirmation.