Acute Abdomen caused by Intracystic Hemorrhage into an Ovarian Endometrioma: Case Report

Toru Shirogane, Ken Kikuchi, Y Yamashita, Naoki Takeda
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2013 · vol. 29(2) , pp. 514–519 · doi:10.5180/jsgoe.29.514 · W2327614601
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This case report details a 29-year-old woman who presented with acute abdomen due to intracystic hemorrhage into a large ovarian endometrioma, which resolved with conservative management and subsequent cystectomy.

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This case report describes a 29-year-old woman who presented with an acute abdomen due to intracystic hemorrhage within a large ovarian endometrioma, rather than a cyst rupture. Magnetic resonance imaging confirmed a significant hematoma inside the cyst, and despite elevated tumor markers suggesting potential leakage, conservative management was chosen because the patient declined surgery. The patient’s condition improved spontaneously as the hematoma dissolved and the cyst size decreased, leading to a scheduled laparoscopic cystectomy six months later which confirmed the benign endometrioma diagnosis. This paper is centrally about endometriosis — specifically the complication of intracystic hemorrhage in ovarian endometriomas causing acute abdominal symptoms.

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Abstract

Cases of an acute abdomen caused by a rupture of an ovarian endometrioma commonly occur. We report a case of an acute abdomen that was not caused by a rupture of ovarian endometrioma' rather, it was due to an intracystic hemorrhage with a large hematoma within an ovarian endometrioma. The patient was a 29-year-old, gravida 1, para 0 single woman. MRI revealed a left ovarian intracystic hemorrhage with a hematoma (7.0 × 7.0 cm) within the cyst (12.2 × 9.0 cm). On admission, she was in relatively good condition, with normal laboratory findings. Moreover, she preferred to avoid surgery. Thus, conservative therapy was administered. Eight days after admission, CA125 (217.0 IU/ml), CA19-9 (75.8 IU/ml) and D-dimer (1.1 μg/ml) were elevated; in addition, slight leakage of liquid contents from the ovarian cyst into the vesicouterine excavation was noted. Rupture of an ovarian endometrioma was suspected; however, her condition and other laboratory data were within normal limits. Since she declined surgery, she was discharged the next day and followed as an outpatient. During outpatient care, CA125 and CA19-9 gradually normalized and the ovarian cyst shrunk (9.0 × 6.0 cm) as the hematoma dissolved. She underwent a laparoscopic cystectomy of the left ovarian cyst six months after the initial consultation. The histopathologic diagnosis was a benign endometrioma. This case showed that a large endometrioma can cause an acute abdomen due to intracystic hemorrhage forming a large hematoma. As this is not an intraperitoneal hemorrhage, the symptoms are mild; however, rupture is possible. Therefore, such a case requires meticulous follow-up and appropriate treatment.
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症例報告 嚢胞内出血により急性腹症をきたした卵巣子宮内膜症性嚢胞の1例 2013 年 29 巻 2 号 p. 514-519 詳細 抄録 Cases of an acute abdomen caused by a rupture of an ovarian endometrioma commonly occur. We report a case of an acute abdomen that was not caused by a rupture of ovarian endometrioma' rather, it was due to an intracystic hemorrhage with a large hematoma within an ovarian endometrioma. The patient was a 29-year-old, gravida 1, para 0 single woman. MRI revealed a left ovarian intracystic hemorrhage with a hematoma (7.0 × 7.0 cm) within the cyst (12.2 × 9.0 cm). On admission, she was in relatively good condition, with normal laboratory findings. Moreover, she preferred to avoid surgery. Thus, conservative therapy was administered. Eight days after admission, CA125 (217.0 IU/ml), CA19-9 (75.8 IU/ml) and D-dimer (1.1 μg/ml) were elevated; in addition, slight leakage of liquid contents from the ovarian cyst into the vesicouterine excavation was noted. Rupture of an ovarian endometrioma was suspected; however, her condition and other laboratory data were within normal limits. Since she declined surgery, she was discharged the next day and followed as an outpatient. During outpatient care, CA125 and CA19-9 gradually normalized and the ovarian cyst shrunk (9.0 × 6.0 cm) as the hematoma dissolved. She underwent a laparoscopic cystectomy of the left ovarian cyst six months after the initial consultation. The histopathologic diagnosis was a benign endometrioma. This case showed that a large endometrioma can cause an acute abdomen due to intracystic hemorrhage forming a large hematoma. As this is not an intraperitoneal hemorrhage, the symptoms are mild; however, rupture is possible. Therefore, such a case requires meticulous follow-up and appropriate treatment. © 2013 日本産科婦人科内視鏡学会

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