Presentation
5 day history of right iliac fossa pain.
Patient Data
Transabdominal pelvic ultrasound demonstrates a moderate amount of pelvic free fluid. The right ovary is mildly enlarged, and contains a heterogeneous complex cystic area with some rim vascularity and internal low level echoes suggestive of hemorrhage. This was favored to represent a corpus luteum associated with pelvic rupture. However, given the subacute timeframe and atypical appearance, a delayed presentation of ovarian torsion was strongly considered as a differential, and therefore a laparoscopy was performed.
Surgical photography showing the right ovary with hemorrhagic CL but otherwise normal appearance (no evidence of torsion), normal left ovary and appearances post lancing of the CL with hemorrhage in the pelvis.
Case Discussion
The two differential diagnoses in this case were an atypical appearance of a ruptured corpus luteum and ovarian torsion.
A ruptured corpus luteum is the most likely cause for a moderate to large size pelvic hemorrhage in a non pregnant patient. Ovarian torsion however is by far the more critical diagnosis, therefore in this case a laparoscopy was performed to exclude this.