Haemoperitoneum due to ruptured corpus luteum! managed conservatively-2 case reports and review of literature
Keywords:Haemoperitoneum, Warfarin coagulopathy, Corpus luteal hemorrhage
AbstractMassive or ongoing Haemoperitoneum is an emergency, usually surgical, managed by laparotomy. Haemoperitoneum seen by gynecologists in clinical practice is usually due to ruptured ectopic. Other causes of haemoperitoneum are traumatic rupture of vascular organs like spleen or liver which are managed by general surgeons. Spontaneous haemoperitoneum (SH) due to bleeding corpus luteum secondary to warfarin induced coagulopathy is encountered very rarely. Bleeding complication in warfarin coagulopathy has high mortality up to 10%. Two cases of warfarin induced significant haemoperitoneum, due to bleeding corpus luteum were managed conservatively, with joint consultation with hematologist and cardiologist. Reversal of anticoagulation usually arrests further bleeding and haemoperitoneum got absorbed as in first case or was drained out in second case. No difference in postoperative period was seen in both cases. Laparoscopy or laparotomy may be needed very rarely after haemostatic control. Emphasis is placed on continuous monitoring in HDU/ICU. Patients on anticoagulant therapy can rarely present with life threatening haemoperitoneum, secondary to ruptured corpus luteum Early diagnosis and reversal of anticoagulation can be lifesaving in this condition which carries significant mortality Unlike ruptured ectopic, ruptured corpus luteum causing haemoperitoneum due to warfarin induced coagulopathy can be managed conservatively, as bleeding stops after reversal of anticoagulation. However a strict continuous monitoring of hemodynamic status and hematology investigations in high dependency unit is required. A heightened awareness of these cases is required due to paucity of available reported literature.
Tresch DD, Halverson G. Ovarian (corpus luteum) hemorrhage during anticoagulation therapy. Ann int med. 1978;88(5):642-6.
Stenchever M. Comprehensive gynecology. 5-th edition. USA, Mosby. 2007. pp. 460-461.
Novak ER, Woodruff JD. Novak's Gynecologic and Obstetric Pathology: With Clinical and Endocrine Relations, 7th ed, Philadelphia, Saunders. 1974. pp. 335.
Saour JN, Sieck JO, Mamo LA, Gallus AS. Trial of different intensities of anticoagulation in patients with prosthetic heart valves. N Engl J Med. 1990;322(7):428-32.
Crétel E, Cacoub P, Gompel A. Ovarian hemorrhage with hemoperitoneum leads to complication of oral treatment using indirect anticoagulant administered by the oral route. La Revue de Médecine Interne. 2000;21:428-34.
Gupta A, Gupta S, Manaktala U. Conservative management of corpus luteum haemorrhage in patients on anticoagulation: a report of three cases and review of literature. Arch Gynecol Obstet. 2015;291(2):427-31.
Fiaschetti V, Ricci A. Hemoperitoneum from Corpus Luteal Cyst Rupture: A Practical Approach in Emergency Room Case Rep Emerg Med. 2014:252657.
Ho WK, Wang YF, Wu HH, Tsai HD, Chen TH, Chen M. Ruptured corpus luteum with hemoperitoneum: case characteristics and demographic changes over time. Taiwan J Obstet Gynecol. 2009;48:108-12.
Barillari G, Pascal S. Emergency reversal of anticoagulation: from theory to real use of prothrombin complex concentrates. A retrospective Italian experience Blood Transfus. 2012;10(1):87-94.
Gupta N, Dadhwal V, Deka D, Jain SK, Mittal S. Corpus luteum hemorrhage: rare complication of congenital and acquired coagulation abnormalities. The Journal of Obstetrics and Gynaecology Research. 2007;33(3):376-80.
Tanaka T. Non-operative Management of Idiopathic Ovarian Hemorrhage with Massive Intraabdominal Hemorrhage .Osaka City Medical Journal. 1997;43:7-14.
Murao H, Kinjyo, K. Demura T. Conservative therapy for corpus luteum hemorrhage, a review of 116 cases. Clin. Gynecol. Obstet. 1994;48:568-72.
Fong YI, Chua HW, Singh C. Diagnostic Dilemma: Acute Abdomen from Ruptured Corpus Luteum Requiring Surgical Intervention in Young Women. Thai Journal of Obstetrics and Gynecology. 2013;21:80-6.
Sikka P, Joshi B, Aggarwal N, Suri V. Corpus Luteal Hemorrhage in Coagulopathy; A Case Report with Review of Treatment Modalities. Austin J Obstet Gynecol. 2015;2(2):1038.
Sonmezer M, Atabekoglu C, Cengiz B, Dokmeci F, Cengiz SD. Depot medroxyprogesterone acetate in anticoagulated patients with previous hemorrhagic corpus luteum. Eur J Contracept Reprod Health Care. 2005;10:9-14.
Payne JH, Maclean RM, Hampton KK, Baxter AJ and Makris M. Haemoperitoneum associated with ovulation in women with bleeding disorders: the case for conservative management and the role of the contraceptive pill. Haemophilia. 2007;13:93-7.
Rice CF, Killick SR, Dieben T and Coelingh Bennink H. A comparison of the inhibition of ovulation achieved by desogestrel 75 micrograms and levonorgestrel 30 micrograms daily. Hum Reprod. 1999;14:982-5.