Management of peritoneal hemorrhage due to follicle rupture under anticoagulation therapy

Severe bleeding into the peritoneal cavity from a ruptured ovulatory follicle is a rare complication in women receiving anticoagulation therapy. A number of both surgical and non surgical methods have been proposed to solve this problem. We adopted a novel therapeutic approach in a 40-year old patient who presented with recurrent acute hemoperitoneum under anticoagulation therapy for combined cardiac valve disease. The hemoperitoneum was successfully managed twice by laparoscopy. The patient then received intranasal GnRH analogue treatment together with transdermal estradiol and oral medroxyprogesterone-acetate. In this way ovarian sex steroids were replaced while cessation of ovarian function was achieved by the hypogonadotrophic condition. At the end of this mode of treatment no recurrence of a hemoperitoneum was seen in our patient. We therefore suggest that considerable gains may be expected from this method for the management of recurrent acute peritoneal hemorrhage caused by ovulation bleeding in patients under anticoagulation therapy.