Pitfall in the treatment of endometriosis: A case of hemoperitoneum during pregnancy after laparoscopic surgery

Yoichiro Fujiwara, Yuki Kozono, Hitomi Ohi, Naochika Oida, Akino Morisaki, Yoshiharu Yamada, Shuji Hosoda
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2011 · vol. 27(2) , pp. 485–488 · doi:10.5180/jsgoe.27.485 · W2330406677
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

A case report highlights hemoperitoneum during pregnancy in a patient with a history of laparoscopic endometriosis treatment, likely due to fragile, decidualized ectopic tissue exacerbated by prior surgery.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This paper reports a case study of a 32-year-old primigravida who developed hemoperitoneum at 36 weeks and 1 day, leading to cesarean delivery, after laparoscopic surgery performed four months earlier for endometriosis and infertility. At cesarean/laparotomy, bleeding originated from sites corresponding exactly to areas identified during the prior laparoscopy, with total blood loss approaching 5,000 mL, managed with hemostasis and transfusion. The authors conclude that ectopic endometriotic tissue becomes decidualized during pregnancy, making it fragile and prone to bleeding, and that prior surgical intervention for deep infiltrating endometriosis may further increase friability of surrounding vessels and tissues. This paper is centrally about endometriosis — it describes hemoperitoneum during pregnancy as a consequence of prior laparoscopic treatment for endometriosis.

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Abstract

Objective: To discuss the risk of hemoperitoneum during pregnancy after laparoscopic surgery for the treatment of endometriosisCase: A 32-year-old primigravida underwent Cesarean section at 36 weeks and 1 day gestation due to hemoperitoneum and non-reassuring fetal status. Four months before her pregnancy, she had undergone laparoscopic surgery for the treatment of endometriosis and infertility. At laparotomy, bleeding was noted from a left ovarian endometrioma and at the right sacro-uterine ligament, points which were exactly coincident with those identified during the laparoscopic procedure. Total blood loss approached 5,000 mL, but the patient was resuscitated after appropriate hemostasis and transfusion. Conclusion: Ectopic endometriotic tissue is known to be decidualized during pregnancy, becoming very fragile and prone to bleeding. Therefore, endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. In addition, surgical intervention for peritoneal endometriotic lesions makes surrounding vessels and tissues more friable and exacerbates the fragility. Therefore, careful attention must be paid during pregnancy in women who have a history of surgical intervention for deep infiltrating endometriosis.
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Abstract

Objective: To discuss the risk of hemoperitoneum during pregnancy after laparoscopic surgery for the treatment of endometriosis Case: A 32-year-old primigravida underwent Cesarean section at 36 weeks and 1 day gestation due to hemoperitoneum and non-reassuring fetal status. Four months before her pregnancy, she had undergone laparoscopic surgery for the treatment of endometriosis and infertility. At laparotomy, bleeding was noted from a left ovarian endometrioma and at the right sacro-uterine ligament, points which were exactly coincident with those identified during the laparoscopic procedure. Total blood loss approached 5,000 mL, but the patient was resuscitated after appropriate hemostasis and transfusion.

Conclusion

Ectopic endometriotic tissue is known to be decidualized during pregnancy, becoming very fragile and prone to bleeding. Therefore, endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. In addition, surgical intervention for peritoneal endometriotic lesions makes surrounding vessels and tissues more friable and exacerbates the fragility. Therefore, careful attention must be paid during pregnancy in women who have a history of surgical intervention for deep infiltrating endometriosis. Case: A 32-year-old primigravida underwent Cesarean section at 36 weeks and 1 day gestation due to hemoperitoneum and non-reassuring fetal status. Four months before her pregnancy, she had undergone laparoscopic surgery for the treatment of endometriosis and infertility. At laparotomy, bleeding was noted from a left ovarian endometrioma and at the right sacro-uterine ligament, points which were exactly coincident with those identified during the laparoscopic procedure. Total blood loss approached 5,000 mL, but the patient was resuscitated after appropriate hemostasis and transfusion.

Conclusion

Ectopic endometriotic tissue is known to be decidualized during pregnancy, becoming very fragile and prone to bleeding. Therefore, endometriosis is a risk factor for spontaneous hemoperitoneum during pregnancy. In addition, surgical intervention for peritoneal endometriotic lesions makes surrounding vessels and tissues more friable and exacerbates the fragility. Therefore, careful attention must be paid during pregnancy in women who have a history of surgical intervention for deep infiltrating endometriosis. © 2011 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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endometriosisdie_deep_infiltratingendometriomainfertility

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