Ruptured hemorrhagic luteal cyst

Specialty: Gynecology and breast.

• Rupture of corpus luteum cyst
• hemoperitoneum due to ruptured corpus luteum
• acute ovulatory bleeding

Why it occurs

• Rupture of the wall of a corpus luteum cyst (formed physiologically after ovulation in the second half of the cycle) that suffers massive intrathecal hemorrhage or dehiscence spontaneously or triggered by vigorous intercourse, releasing fresh blood and follicular fluid into the peritoneal cavity

Initial workup

Quantitative determination of serum beta-hCG (essential to differentiate it from a ruptured ectopic pregnancy). Urgent transvaginal ultrasound (shows an ovary with an image of a corpus luteum cyst with irregular, collapsed walls or with a Doppler "ring of fire", associated with dense echogenic free fluid in the pouch of Douglas and perihepatic space that confirms hemoperitoneum). Immediate and serial complete blood count every 6 hours to monitor the drop in hematocrit and hemoglobin.

Standard management

• There are no drugs to stop active bleeding immediately. If the patient is hemodynamically stable and the peritoneal bleeding is self-limited, conservative in-hospital management is chosen under close monitoring of vital signs, absolute rest and controlled analgesia with Paracetamol 1 g intravenously every 8 hours or Nolotil (Metamizol) 2 g intravenously. If there is hemodynamic instability, progressive massive hemoperitoneum or severe drop in hemoglobin (<7-8 g/dL), urgent laparoscopic surgery is required to perform electrocoagulation of the ovarian bleeding bed, conservative cystectomy and copious lavage of the peritoneal cavity (note: avoid unnecessary oopherectomy to preserve ovarian reserve in young women).