Spontaneous hemoperitoneum in the second trimester of pregnancy with a favorable outcome: a case report

Spontaneous hemoperitoneum in pregnancy is extremely rare but may cause severe hemorrhage, resulting in a high rate of mortality. We report a case of a primigravid woman who complained of middle-upper abdominal pain. She was admitted to our department at 24 + 6 weeks of in vitro fertilization gestation with a surgical history of endometriosis. The patient's non-specific presentation posed diagnostic difficulties and intestinal obstruction was initially suspected. Emergent computed tomographic findings showed massive free abdominal fluid, which was suspected to have arisen from the left ovary or uterus. During an emergency exploratory laparotomy, she had interrupted suturing of a ruptured left uterine subserosal vein performed. Computed tomographic imaging is more helpful for isolating the source of bleeding than ultrasound. Prompt action of an exploratory laparotomy can result in favorable outcomes for the mother and newborn in spontaneous hemoperitoneum in pregnancy.