Ruptured endometrioma

Case contributed by Dr Rania Adel Anan

Presentation

Young female presented with acute pelvic pain. Acute appendicitis was suspected.

Patient Data

Age: 25 years
Gender: Female

Trans-abdominal ultrasonography revealed large pelvic cyst with irregular contour and homogeneous ground-glass echotexture seen at the right iliac fossa region (closely related to the medial aspect of the right ovary). No detected internal vascularity or septations.

Mild amount of free fluid with echogenic debris seen at the right iliac fossa region and Morrison's pouch (indicating hemoperitoneum).

Aspiration of the pelvic free fluid revealed dark brown fluid.

Case Discussion

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.

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