The management of gynecological hemoperitoneum found to be associated with a ruptured corpus luteum cyst

Rupture of a corpus luteum cyst (RCLC) is the major cause of gynecological hemoperitoneum. RCLC is often difficult to diagnose on imaging and a standardized management is not defined. While mild cases of hemoperitoneum associated with RCLC require only observation and support, surgical intervention is necessary for severe cases or if the adnexal cyst in question is concerning for malignancy or torsion. Our study compares the outcomes of patients undergoing conservative and surgical management of gynecological hemoperitoneum found to be associated with RCLC. We performed a retrospective chart review of non-pregnant patients with a diagnosis of hemoperitoneum, corpus luteum cyst rupture, or follicular cyst rupture of the ovary between September 2007 and January 2013. The clinical characteristics, laboratory findings, and radiological findings of the women hospitalized and conservatively monitored or who underwent laparoscopy or laparotomy were reviewed for short-term and long-term adverse outcomes. Data were analyzed using Fisher’s exact test or chi-square test for categorical data and the Mann-Whitney U test for continuous data between the comparison groups. Of 30 women appearing with gynecological hemoperitoneum associated with an adnexal cyst, 5 (17 %) underwent conservative management and 25 (83 %) underwent surgical management including laparotomy (n = 11, 37 %) and laparoscopy (n = 14, 47 %). Patients predominantly presented with pelvic or abdominal pain (93 % of patients). On imaging, RCLC (or ovarian mass) was visualized on the left side in 50 % of the cases. Women younger than 30 years old were more likely to be conservatively managed (p = 0.045) and all cases of radiological concern for malignancy were surgically managed. The correct diagnosis of RCLC was made preoperatively in only 40 % of surgically managed cases. No significant difference was seen in either short-term or long-term outcomes between the two groups. RCLC is a difficult diagnosis that can appear similar to torsion or malignancy on imaging and can prompt surgical management. Though our study size was small, there was no significant difference between conservative and surgical management options in terms of short and long-term adverse outcomes in the management of ruptured corpus luteum cyst-associated hemoperitoneum.