Unusual presentation of a spontaneous broad ligament hematoma during pregnancy unmasking endometriosis in a primigravida inadvertently: a rare case report

Abstract

Spontaneous broad ligament hematoma during pregnancy is an extremely rare obstetric emergency that can present with acute abdomen and hemodynamic instability. It is usually associated with trauma, uterine rupture, or vascular abnormalities. Association with endometriosis is uncommon, particularly in women with spontaneous conception. We present a rare case series of spontaneous broad ligament hematoma in a primigravida and another patient with previous vaginal delivery, both having spontaneous conception, having no presenting complaints other than obstetric indication for which lower segment caesarean section was done. Spontaneous hematomas were an incidental finding in both cases, where in previously undiagnosed endometriosis was identified intra-operatively with unusual spontaneous hematomas extending to the posterior surface of uterus. Every lower segment caesarean section should be complemented with thorough exploration of posterior surface and adnexa including the peritoneal surfaces to look for any endometriotic spot, hematoma or any other unusual finding before final closure to prevent any adversity of materno-fetal outcome.