Endometriosis cause a spontaneous Hemoperitoneum in a non-pregnant women after stopping Dienogest therapy: A case report

Introduction Endometriosis as one of the most common gynaecological disorders afflicting women of childbearing age, around 30 % suffer from it. Some women show almost no signs of symptoms in spite of severe endometriosis, others experience the most severe incapacitating lower abdominal pains with a mild endometriosis.

Case report We are concerned here with the case of a 31 year-old nulliparous female patient, who presented to the Emergency Unit at our hospital because of lower abdominal pain as well as upper abdominal pain for over six hours. About three weeks ago, she had stopped the Visane pill due to a strong wish to have a child. In her clinical anamnesis, there was the status after a right ovarian endometrioma Surgery.

With suspicion of an active intra-abdominal haemorrhage, an immediate laparoscopy was indicated. At this point in time, the haemoglobin value had sunk to 87 g/l. Intraoperatively, 3L of blood was aspirated. There was an active bleeding from the parametrium on the right side, where the endometrioma was removed years ago.We suspect that the hemoperitoneum was caused by a rupture of the uterine artery. A fertility consultation was also carried out, including an extensive discussion on the significance of endometriosis rASRMV° for fertility and the means for AMH in the lower region.

Conclusion Spontaneous hemoperitoneum is a rare and life-threatening complication of endometriosis. Patients of childbearing age with hemoperitoneum should be concerned about endometriosis. The Potential occurrence of haemorrhagic shock associated with endometriosis, depending on the implantation site, need to be recognized.

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Artikel online veröffentlicht:
07. Oktober 2020