Spontaneous hemoperitoneum in pregnancy due to endometriosis. Issue 3 (September 2020)

• Record Type: Journal Article
• Authors: Kim, Tesia G; Sudhof, Leanna S; Liu, Fong W; Shainker, Scott A
• Is Part Of: Journal of endometriosis and pelvic pain disorders. Volume 12:Issue 3/4(2020)
• Page Start: 124
• Page End: 127
• Publication Date: 2020-09
• Subjects: Imaging -- laparotomy -- surgical treatment -- endometriosis -- medical treatment -- pelvic adhesions -- pain; Endometriosis -- Periodicals; Pelvic pain -- Periodicals; 618.1
• DOI: 10.1177/2284026520942432
• Languages: English
• ISSNs: 2284-0265

Abstract

Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.