Sonographic findings along with the dark brown fluid aspiration and patient clinical presentation are impressive of a ruptured endometrioma. The diagnosis of acute appendicitis was excluded. Better evaluation by transvaginal ultrasound was limited as the patient was a virgin.
The rupture of an endometrioma is a rare event, with an estimated incidence of <3% among women of childbearing age who are known to have endometriomas 2. This situation occurs more commonly during pregnancy, due to hormonal stimulation of endometrial stromal elements 1, albeit with larger (≥6.0 cm) lesions 3.