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Idiopathic spontaneous haemoperitoneum at 4 weeks gestation
Emily O'Brien1,2, Rehan Feroz1, Sona Jasani3
1Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.
BMJ Case Reports
|September 13, 2021
Summary
A young woman experienced severe abdominal pain due to spontaneous hemoperitoneum during early pregnancy. This rare condition required surgical intervention and highlights the importance of considering pregnancy-related causes in such cases.
Area of Science:
- Obstetrics and Gynecology
- Emergency Medicine
- Surgical Case Reports
Background:
- Acute abdominal pain in early pregnancy necessitates prompt diagnosis and management.
- Spontaneous hemoperitoneum, while rare, can present as a critical surgical emergency.
- Pregnancy of unknown location poses diagnostic challenges, especially with atypical presentations.
Observation:
- A 20-year-old nulliparous patient presented with acute abdominal pain and imaging suggestive of hemoperitoneum.
- Initial hemodynamic stability deteriorated, leading to two diagnostic laparoscopies revealing significant hemoperitoneum without a clear bleeding source.
- Serial beta-human chorionic gonadotropin (β-hCG) levels and ultrasound confirmed a viable intrauterine pregnancy.
Findings:
- The patient experienced recurrent hemoperitoneum, with initial findings of 1200 mL and later 50 mL.
- No identifiable intra-abdominal bleeding source was found during laparoscopies.
- Despite the hemoperitoneum, a viable pregnancy was confirmed and continued.
Implications:
- This case underscores the critical need to consider spontaneous hemoperitoneum in pregnancy, even with early or unknown pregnancy status.
- Early recognition and appropriate management are vital for maternal and fetal outcomes in such unusual obstetric emergencies.
- The differential diagnosis for acute abdomen in pregnancy should include spontaneous hemoperitoneum, particularly in cases of pregnancy of unknown location.
