Speaker
Description
Introduction:
Spontaneous hemoperitoneum in endometriosis is rare. We present here the case of a nulliparous woman, who presented with recurrent spontaneous hemoperitoneum, and discuss the management and challenges faced during the COVID-19 pandemic
Case:
A 28 year old nulliparous woman was referred with abdominal distension and pain. Her last menstrual period was 20 days back. She had been evaluated earlier for primary subfertility. Diagnostic hystero-laparoscopy had been performed in 2015, where frozen pelvis was documented. Subsequently, she underwent 2 emergency laparoscopic procedures for hemoperitoneum, and histopathology of the right ovarian cystectomy specimen revealed ruptured corpus luteum. She had received a course of empirical antitubercular therapy. Paracentesis had been performed 5 times previously.
Result:
Upon presentation, her vitals were stable and pallor was present. There was mild abdominal distension. Ultrasonography revealed significant haemoperitoneum, and MRI confirmed endometriosis. Her hemoglobin was 6.8g%, urine pregnancy test was negative and coagulation profile was normal. She received 1 unit of packed cell transfusion. In view of COVID-19 pandemic and stoppage of elective laparoscopic surgeries, imaging guided pig tail catheter insertion and drainage was performed. Around 3.7 litres of haemorrhagic fluid was drained. Tubercular and bleeding disorder workup was negative. She was started on continuous OCPs and at 2 months follow up, she was asymptomatic with minimal ascites
Discussion:
MRI has greater specificity in the diagnosis of endometriosis. Hemoperitoneum predisposes to deep infiltrating endometriosis. During the COVID-19 pandemic with stoppage of elective laparoscopic surgeries, alternative methods of management have to be adopted
