Ruptured Endometrioma with Hemoperitoneum Requiring Emergency Laparotomy: A Case Report

Sangam Rai, Ganesh Dangal, Aruna Karki, Peru Pradhan, Ranjana Shrestha, Kabin Bhattachan, Sunita Maharajan, Srijana Bhandari, Amog Basnyat
Journal of Nepal Health Research Council · 2024 · vol. 21(4) , pp. 689–691 · doi:10.33314/jnhrc.v21i4.4691 · PMID:38616605 · W4394820251
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This case report details a 28-year-old female who presented with acute abdomen and anemia, ultimately requiring emergency laparotomy for a ruptured right ovarian endometrioma causing significant hemoperitoneum.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This paper studied age at first marriage among Nepali women and identified determinants associated with early marriage using secondary data from the Nepal Demographic and Health Survey 2022. Using a cross-sectional design with two-stage stratified cluster sampling, the authors analyzed age at first marriage and applied multiple logistic regression, assessing model fit with the H-L and Pearson tests. They found that current age, women’s education, region of residence, caste/ethnicity, husband’s education, spouse age difference, and age at first menstruation were significantly associated with early marriage, with especially higher odds among women with no education. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Endometrioma is the localization of endometriosis in ovary which often develops as cyst. The condition can be complicated with infection, torsion and rupture leading to significant hemoperitoneum and ascites. We present here a 28-year female P2 L1 presented with the features of acute abdomen and severe anemia referred from other hospital where pain management was done. She had raised Ca-125 level, negative Urine Beta HCG and USG findings of left endometrioma with degenerating subserosal fibroid. The improvement of her general condition with analgesics was misleading however a static hematocrit level despite blood transfusion raised suspicion of ongoing pathology leading to blood loss and diagnostic paracentesis confirmed the hemoperitoneum while awaiting of CT report. She underwent Emergency Laparotomy which revealed hemoperitoneum of 2000ml and right ruptured ovarian endometrioma measuring and left ovarian cyst measuring 6x6 cm was noted. The postoperative period was uneventful. Keywords: Acute abdomen; case report; endometriosis; hemoperitoneum; ruptured endometrioma.
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Background

In Nepal, a substantial proportion of women marry before the age of 18, which is considered as early marriage (EM). The age at which women marry has a direct impact on fertility patterns, family size, and health outcomes of mothers and children. This study aims to assess the levels of age at first marriage (AFM) and significant determinants associated with EM among Nepali women.

Methods

This is a secondary data analysis for which data were obtained from Nepal Demographic and Health Survey 2022. The survey was based on a cross-sectional study design applying two- stage stratified cluster sampling. The AFM levels were analyzed using basic statistics, and a multiple logistic regression model was utilized to identify significant determinants associated with EM. The model’s fit was evaluated using the H-L (????2) and Pearson's tests.

Results

Current age of women, women’s education, region of residence, caste/ethnicity, husband's education, spouse age difference and age at first menstruation were identified as significant determinants associated with EM. Women with no education face a significantly higher risk of EM – Odds Ratio (OR): 21.67 compared to those with higher education, while from other Terai caste (OR:1.58), and Dalit communities (OR:1.51), and women in Madhesh (OR:2.38) and Karnali (OR:1.94) provinces also exhibited higher risks compared to their reference groups.

Conclusions

The risk of EM is higher among women with no or basic level education, those in Madhesh and Karnali provinces, and from Terai caste and Dalit communities. A large spousal age gap also contributes to this practice. Addressing these issues can help reduce EM among women in Nepal.

Keywords

Determinants; early marriage; Nepal; women. Additional Files Published Issue Section License Copyright (c) 2026 Ishwar Kumar Shrestha, Shankar Prasad Khanal This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute Abdomen, Acute

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