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Postcoital cyst rupture presenting as peritonitis and hemorrhagic shock: A case report
Travis P Martin1, Amanda Chung2, Mary Knotts2
1University of Arizona, College of Medicine Department of Emergency Medicine, Tucson, Arizona 857244, 1501 N. Campbell Ave. 4141 E Calle Henequen, Tucson, AZ 85712, United States of America.
Insights
Severe post-coital pain and shock can signal a ruptured ovarian cyst. This case highlights the importance of prompt diagnosis and surgical intervention for this potentially life-threatening gynecological emergency.
Area of Science:
- Gynecology
- Emergency Medicine
- Surgical Critical Care
Background:
- Presents an unusual case of severe post-coital abdominal pain and hemorrhagic shock.
- Highlights a unique presentation in terms of symptom timing, progression, patient age, and surgical history.
Observation:
- Patient presented with peritonitis and shock post-intercourse.
- Initial CT revealed free fluid; worsening shock necessitated transfer to a tertiary care center.
- Exploratory laparoscopy identified and managed a hemorrhagic ruptured ovarian cyst.
Findings:
- Ruptured ovarian cyst as a cause of severe post-coital pain and hemorrhagic shock.
- Successful emergent surgical management led to patient stabilization.
- Rapid recovery and discharge the following day.
Implications:
- Underscores the potential severity of seemingly benign gynecological complaints.
- Emphasizes the critical role of prompt diagnosis and surgical intervention in managing ruptured ovarian cysts.
- Demonstrates how minimal trauma can precipitate serious complications like cyst rupture.
Introduction:
This report presents an unusual case of severe post-coital abdominal pain and signs of hemorrhagic shock requiring admission to a surgical intensive care unit (SICU) and emergent laparoscopy. This case was unique given the timing and progression of the patient's symptoms, as well as her age, surgical history, and symptomatic progression. Here we document the notable characteristics and treatment of this patient.
Case Presentation:
The patient presented to a local emergency department with signs progressive peritonitis and shock after an episode of non-traumatic intercourse. Her initial computed tomography (CT) scan showed signs of free fluid in the abdomen around the bladder and liver with no definitive source of bleed. She developed worsening shock with severe pain. She was then emergently transferred to a tertiary care center for evaluation by gynecology service and for general trauma surgery evaluation. She was further stabilized in the emergency department, and then admitted to the surgical critical care service. Following additional imaging, she received exploratory surgery with gynecology to control a hemorrhagic ruptured cyst. She remained stable and was discharged the next day.
Conclusion:
This case demonstrated a complication of an often-benign diagnosis, revealing the potential danger of underestimating this chief complaint, as well as the importance of understanding how minimal trauma can lead to cyst rupture.
