Spontaneous Hemoperitoneum in Pregnancy Due to Endometriosis in the Second Trimester

Shota Ikagawa, Mieko Inagaki, Tetsuo Maeda, Reina Miki, Shigeki Yoshida
In: Journal of Clinical Gynecology and Obstetrics · 2024 · vol. 13(1) , pp. 12–17 · doi:10.14740/jcgo926 · W4394682284
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-09 ⓘ

This case report describes a 31-year-old woman in her second trimester of pregnancy who experienced spontaneous hemoperitoneum due to endometriosis, necessitating laparotomy and cesarean section to control bleeding.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This case report describes a 31-year-old primigravid woman who, at 19 weeks’ gestation, developed acute left lower abdominal pain and was found on serial examinations to have intraperitoneal bleeding, but pelvic MRI did not identify a specific source. Despite progressive anemia and worsening pain (with preoperative ultrasound showing intrauterine fetal death), she underwent exploratory laparotomy, which revealed oozing-type active bleeding from three delicate tissues associated with endometriosis, including myometrium and a portion of peritoneum in the vesicouterine excavation. A cesarean section was performed to halt the bleeding and avoid hysterectomy, leading to a diagnosis of spontaneous hemoperitoneum in pregnancy in the second trimester, which the authors note is uncommon and difficult to diagnose early due to subacute symptom progression and limited imaging findings. This paper is centrally about endometriosis — it reports spontaneous hemoperitoneum in pregnancy caused by endometriosis affecting uterine myometrium and adjacent peritoneal tissue in the second trimester.

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Abstract

Spontaneous hemoperitoneum in pregnancy (SHiP) is defined as unprovoked intraperitoneal bleeding during pregnancy or up to 42 days postpartum. A 31-year-old primigravid woman presented to our hospital at 19 weeks of gestation with acute left lower abdominal pain. Upon several examinations, she was found to have intraabdominal bleeding. However, pelvic magnetic resonance imaging (MRI) failed to yield specific findings. The following day, owing to increased pain and progressive anemia, she underwent an exploratory laparotomy. Preoperative ultrasound imaging revealed intrauterine fetal death. Laparotomy revealed oozing-type active bleeding from three delicate tissues related to endometriosis: the myometrium at the uterine anterior and posterior surfaces and a portion of the peritoneum in the vesicouterine excavation. A cesarean section was performed, successfully halting the bleeding and obviating the need for a hysterectomy. She was ultimately diagnosed with SHiP. SHiP in the second trimester is relatively uncommon, and the subacute progression of symptoms made early diagnosis challenging. For a correct diagnosis and appropriate treatments, full consideration of the clinical circumstance is needed without excessive reliance on imaging findings, including MRI, and an early exploratory laparotomy may be the best approach in cases of an unclear source of bleeding. J Clin Gynecol Obstet. 2024;13(1):12-17 doi: https://doi.org/10.14740/jcgo926
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Spontaneous Hemoperitoneum in Pregnancy Due to Endometriosis in the Second Trimester Abstract Spontaneous hemoperitoneum in pregnancy (SHiP) is defined as unprovoked intraperitoneal bleeding during pregnancy or up to 42 days postpartum. A 31-year-old primigravid woman presented to our hospital at 19 weeks of gestation with acute left lower abdominal pain. Upon several examinations, she was found to have intraabdominal bleeding. However, pelvic magnetic resonance imaging (MRI) failed to yield specific findings. The following day, owing to increased pain and progressive anemia, she underwent an exploratory laparotomy. Preoperative ultrasound imaging revealed intrauterine fetal death. Laparotomy revealed oozing-type active bleeding from three delicate tissues related to endometriosis: the myometrium at the uterine anterior and posterior surfaces and a portion of the peritoneum in the vesicouterine excavation. A cesarean section was performed, successfully halting the bleeding and obviating the need for a hysterectomy. She was ultimately diagnosed with SHiP. SHiP in the second trimester is relatively uncommon, and the subacute progression of symptoms made early diagnosis challenging. For a correct diagnosis and appropriate treatments, full consideration of the clinical circumstance is needed without excessive reliance on imaging findings, including MRI, and an early exploratory laparotomy may be the best approach in cases of an unclear source of bleeding. J Clin Gynecol Obstet. 2024;13(1):12-17 doi: https://doi.org/10.14740/jcgo926

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endometriosis

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