A case of hemorrhagic ascites secondary to endometriosis
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The present case has been published in the Amercian Journal of Emergency Medicine.

A previously healthy 27-year-old nulliparous woman presented to ED complaining of right-sided neck and flank pain. She also noted lightheadedness and palpitations and had reported to an ED the day before for abdominal pain of unclear cause. Her medical history was notable for iron deficiency anemia and endometriosis, and current medications included oral contraceptives (OCPs) and iron sulfate.

Upon arrival to the ED, the patient initially appeared comfortable and afebrile, with a blood pressure of 122/72 mm Hg, heart rate of 117 beats per minute, respiratory rate of 16 breaths per minute, and an oxygen saturation as measured by pulse oximetry of 100% on room air.

Her abdomen appeared mildly distended without a noticeable fluid wave. She was tender to palpation in the right upper quadrant without rebound or guarding and with a negative Murphy sign. A transabdominal bedside ultrasound revealed a large amount of intra-abdominal free fluid.

Intravenous (IV) normal saline was begun as the patient became progressively orthostatic, with an episode of syncope upon standing and subsequent blood pressures of 90/60 mm Hg. Shortly thereafter, she was found to have a hemoglobin level of 7.0 g/dL and a negative human chorionic gonadotropin.

One unit of packed red blood cells (PRBCs) in addition to a total of 2 L of IV normal saline was given with improvement of her blood pressure to 104/73 mm Hg.

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