Ruptured Ovarian Endometrioma During Pregnancy: A Case Report and Review Highlighting Clinically Occult Risk Factors

The rupture of an ovarian endometrioma during pregnancy is a rare cause of acute abdominal pain, and its underlying risk factors are incompletely understood. We report a case of ovarian endometrioma rupture during pregnancy complicated by dense intra-abdominal adhesions and review previously reported cases to clarify potential risk factors. Twenty cases, including our case, were analyzed. Among cases with available data, 78.5% involved cysts measuring ≥6 cm, consistent with previous reports identifying large cyst size as a major risk factor. Adhesions were reported in seven cases, although most studies did not explicitly comment on their presence or absence. Regarding gestational age, 50% of cases occurred during the third trimester, and all cases presenting at ≥32 weeks of gestation were delivered by cesarean section. Beyond visible risk factors, such as cyst size and gestational age, clinically occult factors, including intra-abdominal adhesions, may also contribute to rupture risk. Careful early assessment and documentation of ovarian endometriomas may support clinical decision-making; however, the preventive role of pre-pregnancy surgical intervention warrants further investigation.