Spontaneous Hemoperitoneum in Endometriosis: A Case Report

Background: Primary presentation of endometriosis with spontaneous hemoperitoneum is rare. We report a 22-year-old woman presenting with endometriosis with spontaneous hemoperitoneum. Case: A 22-year-old woman was referred with history of abdominal distension and pain along with loss of appetite for 2 months and melena for 2 days. There was marked abdominal distension with fluid thrill and guarding for which abdominal tuberculosis was suspected but ruled out by cartridge based nucleic acid amplification test (CBNAAT) and culture. Ultrasonography of abdomen showed a cystic lesion of size 42 x 35 mm in right adnexa with internal echoes and presence of significant septate peritoneal fluid with low level echoes. Review of history with us revealed severe dysmenorrhea for the past 10 years. Magnetic resonance imaging was carried out that showed mildly enlarged bilateral ovaries containing cysts of varying signal intensities, with significant peritoneal fluid collection with septations, suggestive of endometrioma with hemoperitoneum. Results: Diagnostic laparoscopy was performed, which was converted to laparotomy due to technical difficulty. Intraoperatively, 2 L of thick coffee-colored fluid was drained. Endometrial implants were noted on the peritoneal surfaces, with sigmoid colon being densely adherent to the Pouch of Douglas. Adhesiolysis along with right ovarian cystectomy was done. Histopathology confirmed the diagnosis. She was treated with injection goserelin postoperatively, and was asymptomatic at 3 months and 1 year follow-ups. Conclusions: Primary presentation of endometriosis with spontaneous hemoperitoneum is rare. Endometriosis should be kept in the differential diagnosis of a woman in the reproductive age presenting with spontaneous hemoperitoneum.