Acute Abdomen Due to Ruptured Hemorrhagic Ovarian Cyst in a Patient with Endometriosis
Acute Abdomen Due to Ruptured Hemorrhagic Ovarian Cyst in a Patient with Endometriosis
Dr. Hema Jajoo
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2 min read
Patient's Initial Condition
Symptoms / Health Concerns
Sudden, severe lower abdominal pain with a known history of endometriotic ovarian cyst.
Duration of Symptoms
Sudden onset of acute, severe abdominal pain. Exact duration not specified.
Previous Treatments
Conservative management was attempted, but the pain persisted and did not respond adequately.
Diagnosis
Final Diagnosis
Ruptured hemorrhagic cyst in the opposite ovary causing hemoperitoneum, with an existing endometriotic ovarian cyst and associated pelvic adhesions.
Tests / Scans / Investigations
Clinical evaluation and MRI of the pelvis to identify the cause of acute abdominal pain.
Treatment Details
Operative laparoscopy, drainage of hemoperitoneum, ovarian cystectomy for the endometriotic cyst, extensive adhesiolysis, management of the ruptured hemorrhagic cyst, and coagulation of active bleeding points.
Advanced Techniques Used
Minimally invasive laparoscopic surgery, pelvic adhesiolysis, management of ovarian bleeding, and ovarian tissue preservation as far as possible.
Results & Recovery
Patient Improvements
Dramatic relief from abdominal pain following surgery, with successful management of the ruptured hemorrhagic cyst, endometriotic cyst, and associated pelvic adhesions.
Final Outcome
The patient recovered well and is currently asymptomatic.
Returned to Normal Activities: Yes
Case Highlights
What Makes This Case Unique
The patient's acute abdominal pain initially suggested ovarian torsion. However, pelvic MRI identified a ruptured hemorrhagic cyst in the opposite ovary, with significant blood accumulation in the abdominal cavity. The case demonstrates the importance of investigating alternative causes of acute abdominal pain in patients with known endometriosis.
Complex / Rare Factors
Yes. The coexistence of an endometriotic ovarian cyst, a ruptured hemorrhagic cyst in the opposite ovary, hemoperitoneum, and pelvic adhesions made the case clinically challenging.
Most Significant Benefit
Rapid relief of severe abdominal pain, control of active bleeding, treatment of endometriosis and pelvic adhesions, and preservation of ovarian tissue as far as possible.
Conclusion
This case highlights the importance of accurate diagnosis in patients presenting with acute abdominal pain and a known endometriotic ovarian cyst. MRI helped identify the actual cause of the acute presentation, and operative laparoscopy enabled treatment of the ruptured hemorrhagic cyst, endometriotic cyst, and pelvic adhesions. The patient recovered well and is now asymptomatic.