Hemoperitoneum Following Sexual Intercourse in a Woman with Deep Infiltrating Endometriosis

Abstract

Endometriosis is an estrogen-dependent chronic inflammatory disease, defined by the presence of endometrial glands and stroma at ectopic sites. A rare and life-threatening complication associated with endometriosis is represented by spontaneous hemoperitoneum due to the rupture of utero-ovarian vessels. Most cases of spontaneous hemoperitoneum previously described involved pregnant women affected by endometriosis; here, we present a case of acute and massive hemoperitoneum in a nulliparous woman with deep infiltrating endometriosis. When acute abdominal pain with hemoperitoneum occurs in non-gravid reproductive age women, with no positive findings for liver or spleen lesions, a possible spontaneous rupture of utero-ovarian vessels related to the presence of deep infiltrating endometriosis should be included among the possible causes of the condition.

Laparoscopic hemostasis for abdominal brunt massive hemorrhage due to endometriosis

“…9 Additionally, Buggio et al reported that sexual intercourse could be a cause of utero-ovarian vessel rupture in a woman with endometriosis. 5 These reports suggest that chronic inflammation caused by endometriosis may render the pelvic vessels more friable, and physical stretching of the endometrial adhesion caused by menstruation or sexual intercourse may result in vessel rupture. In the present case, severe endometriotic adhesions were extensively observed as a characteristic finding.…”

“…Both cases had spontaneous acute hemoperitoneum from the uterine artery eroded by an endometriotic lesion; wherein, one case was asymptomatic and occurred during menstruation 9 . Additionally, Buggio et al reported that sexual intercourse could be a cause of utero‐ovarian vessel rupture in a woman with endometriosis 5 . These reports suggest that chronic inflammation caused by endometriosis may render the pelvic vessels more friable, and physical stretching of the endometrial adhesion caused by menstruation or sexual intercourse may result in vessel rupture.…”

“…3 Hemoperitoneum is a rare but serious complication of endometriosis. There are some reported cases where pregnancy 4 or sexual intercourse 5 caused hemoperitoneum due to endometriosis.…”

Acute abdominal pain in non-pregnant endometriotic patients: not just dysmenorrhoea. A systematic review

“…In the two reported cases of kidney endometriotic implants, endometriosis was never considered a possible aetiology for the symptoms. Interestingly, Buggio et al (2016) and Togami et al (2015) reported two cases of haemoperitoneum, one spontaneous and one after sexual intercourse, in which endometriosis was not suspected until exploratory surgery.…”

“…Two patients had already received a diagnosis of endometriosis either at diagnostic laparoscopy or ultrasound (Janicki et al 2002;Togami et al 2015). The haemoperitoneum was spontaneous in two cases, whereas in one patient, it occurred just after sexual intercourse (Buggio et al 2016).…”