Massive Haemoperitoneum Postovulation: A Rare Complication of Unmonitored Anticoagulant Therapy

Abstract

Derangements in coagulation profile due to on-going anticoagulant medication can complicate the most primitive physiology in a woman, ovulation. Unmonitored anticoagulant therapy can lead to an array of complications, one of which is intraperitoneal haemorrhage secondary to numerous medical and surgical conditions. The resultant haemoperitoneum can cause sudden hypovolemic shock, especially in a patient with compromised cardiovascular status. This report narrates the case of a 30 years old nulliparous female patient on anticoagulant therapy, operated for multiple cardiac defects and developed massive haemoperitoneum as a consequence of ovulation. The patient presented in shock to the Emergency Department with unstable haemodynamic status. A multi-disciplinary approach to the case converged on ruptured functional ovarian cyst as a working diagnosis. Conservative management of haemoperitoneum was decided upon, whereby correcting shock and providing pro-coagulant therapy along with blood products was the main line of management. All efforts failed soon after when the cyst wall ruptured catastrophically, leading to collapse of the general condition of the patient. Surgical approach was undertaken and a ruptured ovarian cyst wall was identified to be the cause. The cyst wall was subsequently repaired electrosurgically and the patient recovered well with an uneventful postoperative period. However, the characteristic feature of this case is the lack of follow-up due to lockdown restrictions of this continuum, the Coronavirus Disease-2019 (COVID-19) pandemic. The management of such cases must be carefully titrated, keeping in mind the risks and benefits of both pro-coagulant and anti-coagulant therapy wherein one can jeopardise the effects of the other.

Post-ovulatory Hemoperitoneum in a Patient on Anticoagulation Therapy for Mitral Valve Replacement

“…The rate of bloodstream to the corpus luteum surpasses any adult organ (each tissue). The enhanced bloodstream provides substrates for hormonal agent manufacturing and supports the quick splitting of luteal cells [ 3 ]. Corpus luteum cysts are thin-walled, practical vascular frameworks, most of which are predisposed to rupture.…”

“…Joshi et al (2022) reported a similar case of hemoperitoneum due to a ruptured corpus luteal cyst secondary to a coagulation defect which was managed by exploratory laparotomy with electrosurgical excision of the cyst wall [ 3 ]. Agarwal et al (2017) India managed the case of a ruptured corpus luteum cyst with hemoperitoneum due to unmonitored warfarin therapy post-mitral valve replacement by conservative methods [ 12 ].…”