Endometriosis-induced massive hemoperitoneum misdiagnosed as ruptured ectopic pregnancy: a case report
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(2020) 14:160
CASE REPORT
Open Access
Endometriosis-induced massive hemoperitoneum misdiagnosed as ruptured ectopic pregnancy: a case report Bong Hyeon Kim1, Seong Nam Park2 and Byoung Ryun Kim2*
Abstract Background: Endometriosis, an estrogen-dependent inflammatory disease, is commonly observed in gynecologic practice. Spontaneous hemoperitoneum is a rare but serious complication of endometriosis. Most cases of endometriosis-induced hemoperitoneum are attributable to a ruptured endometrioma or utero-ovarian vessel hemorrhage. We report a case of massive hemoperitoneum secondary to intra-abdominal bleeding from the peritoneal endometriotic deposits with spontaneous abortion that was misdiagnosed as a ruptured ectopic pregnancy. Case presentation: A 36-year-old Korean woman was admitted to our hospital for acute abdominal pain and vaginal bleeding. She was suspected of ruptured ectopic pregnancy on the basis of a positive serum human chorionic gonadotropin test result and ultrasonographic evidence of pelvic fluid collection. During hospitalization, her symptoms deteriorated with peritoneal irritation sign on physical examination, hypotension, and tachycardia. Emergency exploratory laparoscopy was performed and revealed active bleeding from the peritoneal endometriotic deposit, which was treated with laparoscopic electrocoagulation. The patient’s postoperative course was uneventful. Spontaneous abortion was diagnosed on the basis of decreased serial serum human chorionic gonadotropin level estimation. Conclusions: Although rare, gynecologists should consider endometriosis-induced hemoperitoneum with spontaneous abortion in the differential diagnosis in women of reproductive age presenting with a positive serum human chorionic gonadotropin test result and acute abdomen with intra-abdominal bleeding. Keywords: Acute abdomen, Endometriosis, Hemoperitoneum
Background Endometriosis is an estrogen-dependent inflammatory disease characterized by the deposition of endometrial tissue at extrauterine (ectopic) sites. It is a relatively common condition that mainly affects women of reproductive age [1]. Currently, retrograde menstruation, endometrial stem cell implantation, Müllerian remnant abnormalities, and coelomic metaplasia are among the several theories proposed to explain the pathogenesis of this condition; however, no single theory can conclusively explain all
cases of endometriosis. Clinical manifestations of endometriosis include dysmenorrhea, dyspareunia, dyschezia, dysuria, and intermenstrual pelvic pain, as well as infertility secondary to chronic pelvic inflammation [2]. Endometriosis-related spontaneous hemoperitoneum in pregnancy and endometriosis-related ascites are rare but life-threatening complications observed in a few patients [3–5]. We report the first case of endometriosis-induced massive hemoperitoneum with spontaneous abortion that was misdiagnosed as a ruptured ectopic pregnancy.
* Correspondence: [email protected] 2 Department of Obstetrics and Gynecology, Wonkwang University School of Medici
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