A primigravida with a twin pregnancy presented acute abdominal pain and hypovolemic shock at 33 weeks of gestation. Ultrasound examination revealed the absence of fetal heartbeat in one fetus and serious bradycardia in the other without echographic signs of placental abruption. Immediate laparotomy revealed massive hemoperitoneum resulting from spontaneous rupture of right uterine vessels. Two demised fetuses were delivered by cesarean section and hemostasis was accomplished. According to the literature reported, endometriosis may be involved in the rupture of these vessels.

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El dolor abdomino-pélvico es una entidad compleja, a veces de difícil diagnóstico, que requiere un análisis profundo para determinar sus causas y el tratamiento más adecuado. Implica a diversas vísceras por lo que frecuentemente el abordaje debe ser multidisciplinar y en ocasiones exige una actuación rápida ya que está en juego la vida de la paciente Se han expuesto en este trabajo sólo las causas de origen ginecológico pues entendemos que el resto de patologías corresponde explicarlas a otras especialidades. Se expone un cuadro de diagnóstico diferencial entre las causas más frecuentes de dolor pélvico de origen ginecológico. Palabras clave. Dolor pélvico. Torsión de ovario. Embarazo ectópico. Enfermedad pélvica inflamatoria. Endometriosis.

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Abdominal-pelvic pain is a complex entity, at times difficult to diagnose, which requires a deep analysis to determine its causes and the most suitable treatment. It involves different viscera which is why its management must frequently be multidisciplinary and on occasion it requires rapid action as the patient's life is at stake. This article sets out only the causes with a gynaecological origin since, in our understanding, it corresponds to other specialities to explain the rest of the pathologies. A diagnostic table is set that differentiates amongst the most frequent causes of pelvic pain with a gynaecological origin.