Usefulness of plasma D-dimer levels in detecting ruptured ovarian endometrioma

Itsuki Kajimura, Akira Fujishita, Ai Fukushima, Kanako Matsumoto, Tomoko Yoshitake, Koichi Hiraki
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2018 · vol. 34(1) , pp. 86–94 · doi:10.5180/jsgoe.34.1_86 · W2883564556
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This study investigated the clinical characteristics of ruptured ovarian endometriomas and evaluated the usefulness of plasma D-dimer levels in differentiating ruptured from unruptured cases.

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This study examined clinical characteristics and serum D-dimer levels in women undergoing laparoscopic surgery for ovarian endometrioma at a Japanese gynecology department, comparing those with ruptured endometrioma (n=61), emergency surgery for unruptured endometrioma (n=13), and elective surgery for unruptured endometrioma (n=26). The ruptured group showed higher rebound tenderness, white blood cell count, and C-reactive protein than the unruptured group, and rupture occurred without a definite trigger in most cases, with about half occurring during menstruation. Serum D-dimer was measured in a subset of ruptured cases (n=24) and elective unruptured cases (n=26), and mean D-dimer was higher in ruptured patients (2.2±1.9 μg/mL) than elective unruptured patients, with 79% of ruptured cases exceeding a reported cut-off of <1.0 μg/mL and all elective unruptured cases remaining below. This paper is centrally about endometriosis — it focuses on using plasma D-dimer to detect ruptured ovarian endometrioma.

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Abstract

Objective: We investigated the clinical characteristics of patients with ruptured ovarian endometrioma and examined the role of serum D-dimer levels in ruptured and unruptured ovarian endometrioma.
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原著論文 卵巣チョコレート嚢胞破裂疑い症例における臨床像と血中D-dimer値の検討 2018 年 34 巻 1 号 p. 86-94 詳細 抄録 Objective: We investigated the clinical characteristics of patients with ruptured ovarian endometrioma and examined the role of serum D-dimer levels in ruptured and unruptured ovarian endometrioma. Design: Retrospective and prospective study Setting: Department of Gynecology of Saiseikai Nagasaki Hospital, Japan. Patient(s): Women who had laparoscopic surgery for ovarian endometrioma from April 2009 to April 2017 were enrolled in the study. We classified these women into three groups: those with ruptured endometrioma (n=61), emergency surgery for unruptured ovarian endometrioma (n=13), and elective surgery for unruptured ovarian endometrioma (n=26). Intervention(s): None Main outcome measure(s): The clinical characteristics and serum D-dimer levels of women with ruptured and unruptured ovarian endometrioma were evaluated. Result(s): In the ruptured group, the mean age was 33.8 years, mean ruptured cyst size was 6.4 cm, and rupture occurred on the right side in 27 patients and on the left side in 30 patients. Almost all patients had no definite trigger, and 30 patients (49%) had rupture during the menstrual period. We compared patients in the ruptured and unruptured groups; significant differences were observed in the rebound tenderness (79% vs. 42%,p<0.05), white blood cell count (10,536±4,412/µL vs. 7,269±2,650/µL, put p<0.05), and C-reactive protein level (4.0±5.4 mg/dL vs. 0.5±0.9 mg/dL, p<0.05). In the ruptured group, 55% of ovarian endometriomas were detected preoperatively by transvaginal ultrasonography and 74% by magnetic resonance imaging. We measured serum D-dimer levels in the ruptured group (n=24) and unruptured group with elective surgery (n=26). The mean serum D-dimer level (cut-off level is less than 1.0 μg/mL) was 2.2±1.9 μg/mL in the ruptured group, which was significantly higher than that in the unruptured group (put D-dimer value and p<0.05). In the ruptured group, 79% of patients showed higher serum D-dimer levels, and all patients in the unruptured group with elective surgery showed D-dimer values less than the cut-off levels. Conclusion(s): In addition to routine measurement of conventional parameters, our findings further suggested the clinical usefulness of measuring D-dimer levels in distinguishing patients with ruptured and unruptured ovarian endometrioma. © 2018 日本産科婦人科内視鏡学会

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endometrioma

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