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Endometriosis-Related Hemoperitoneum in Pregnancy: A Diagnosis to Keep in Mind.

BACKGROUND
Endometriosis is an important gynecologic clinical entity, pathologically defined by the ectopic presence of endometrium and frequently associated with pelvic pain, that affects approximately 10% of females of reproductive age. A rare but severe complication of endometriosis during pregnancy is spontaneous hemoperitoneum in pregnancy (SHiP), severe intraabdominal bleeding that can be life threatening.


CASE REPORT
We present the case of a patient with SHiP at 29 weeks of pregnancy. A supraumbilical midline laparotomy was performed, and pelvic exploration revealed a lacerated and bleeding right ovary. Right annessiectomy was performed, and a cesarean section was performed because hemostasis was not achievable. A healthy baby was born, and hemostasis was finally achieved.


CONCLUSION
We believe that in gravid females with a history of endometriosis, severe abdominal pain, and a reduction of hemoglobin, physicians should always suspect SHiP. Because SHiP is a life-threatening condition for both the mother and the baby, a prompt diagnosis must lead to prompt treatment.