Published in:
28-07-2023 | Endometriosis | Pictorial Essay
Recurrent Spontaneous Hemoperitoneum in Endometriosis: A Diagnostic and Therapeutic Conundrum
Published in: The Journal of Obstetrics and Gynecology of India | Special Issue 2/2023
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A 28-year-old nullipara presented with abdominal distension of 3 years duration. She had attained menarche at 13 years of age and had regular menstrual cycles lasting for 5 days and occurring at intervals of 27 days, with history of dysmenorrhoea for the last 9 years. She was married since 10 years and had been trying for conception for the last 8 years. She had undergone diagnostic hystero-laparoscopy for primary subfertility 5 years back documenting frozen pelvis, followed by emergency laparoscopic drainage twice and paracentesis five times for hemoperitoneum. There was no family history of endometriosis. Multidisciplinary team consultations were done with departments of medicine, pulmonary medicine, gastroenterology and hematology to rule out common causes of ascites. Diagnosing her as a case of infiltrative endometriosis with recurrent spontaneous hemoperitoneum, we did ultrasound guided drainage and treated her with long term dienogest. She was asymptomatic at follow-up (Figs. 1, 2, 3 and 4).
Fig. 1
Ultrasound showing A hemoperitoneum (solid arrow) with normal sized uterus (broken arrow) B cystic lesion in right ovary (solid arrow) with adhesions on the posterior surface of uterus (broken arrow) suggestive of infiltrative endometriosis
Fig. 2
MRI confirmed hemoperitoneum (thick black arrow), normal sized uterus (thin black arrow) and right ovary with endometrioma (broken white arrow)
Fig. 3
Therapeutic procedure was performed with A insertion of ultrasound guided catheter and B drainage of 3.7 L of haemorrhagic fluid. Tubercular, malignancy and hematological disorders workup was negative. She was started on tablet dienogest
Fig. 4
Follow up ultrasound at 3 months showing normal sized uterus (broken arrow) and urinary bladder (solid arrow) with no intraperitoneal collection or hemoperitoneum
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