Massive haemoperitoneum from an unidentified source in a woman with vWD

Von Willebrand's disease (vWD) is an inherited coagulopathy. In women, this condition can present as periovulatory intra-abdominal bleeding or bleeding from the corpus luteum. A diagnosed case of vWD presented as an emergency with nausea, acute abdominal pain and dizziness. There was no history of amenorrhoea, abdominal trauma or bleeding from any other site. Urine pregnancy test was negative. Intra-abdominal bleeding was suspected as her repeat blood counts showed progressive fall in haemoglobin. Emergency laparoscopy was performed with provisional diagnosis of a ruptured ovarian cyst, which confirmed haemoperitoneum. However, both ovaries were normal and no bleeder was identified despite thorough intraoperative exploration. This case highlights that Von Willebrand factor replacement may suffice as the treatment even if the cause of haemorrhage remains unidentified in vWD. The challenges of undertaking surgery in patients with coagulopathy and perioperative management are discussed.