A Special Case Report of Aggressive Hemorrhage in Posterior Vaginal Fornix DIE

This paper reports a 31-year-old woman hospitalized for sudden, massive recurrent vaginal hemorrhage and found to have an inhomogeneous posterior cervical/vaginal fornix mass on ultrasound, initially raising concern for diagnoses such as trophoblastic disease or cervical pregnancy. High-level workup included biopsy of the posterior vaginal fornix rupture showing chronic inflammation with hemorrhage, low blood hCG to exclude cervical pregnancy, exclusion of cervical tuberculosis, and uterine arteriography to rule out vascular malformation, followed by laparoscopic resection of the posterior vaginal fornix lesion and related procedures with intraoperative rapid pathology and postoperative histology. The final diagnosis was deep endometriosis of the posterior vaginal fornix, with postoperative pathology identifying endometriosis within the cervical/fornix tissue and intraoperative pathology showing chronic active inflammation without malignancy. As a single case report, it has no cohort-level comparison or generalizability, and emphasizes differential diagnosis due to the aggressive hemorrhagic presentation mimicking other conditions. This paper is centrally about endometriosis — it describes a rare case of deep infiltrating endometriosis causing posterior vaginal fornix rupture with aggressive vaginal hemorrhage.

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