Publication:

Haemoperitoneum due to ruptured corpus luteum! managed conservatively-2 case reports and review of literature

Massive or ongoing Haemoperitoneum is an emergency, usually surgical, managed by laparotomy. Haemoperitoneum seen by gynecologists in clinical practice is usually due to ruptured ectopic. Other causes of haemoperitoneum are traumatic rupture of vascular organs like spleen or liver which are managed by general surgeons. Spontaneous haemoperitoneum (SH) due to bleeding corpus luteum secondary to warfarin induced coagulopathy is encountered very rarely. Bleeding complication in warfarin coagulopathy has high mortality up to 10%. Two cases of warfarin induced significant haemoperitoneum, due to bleeding corpus luteum were managed conservatively, with joint consultation with hematologist and cardiologist. Reversal of anticoagulation usually arrests further bleeding and haemoperitoneum got absorbed as in first case or was drained out in second case. No difference in postoperative period was seen in both cases. Laparoscopy or laparotomy may be needed very rarely after haemostatic control. Emphasis is placed on continuous monitoring in HDU/ICU. Patients on anticoagulant therapy can rarely present with life threatening haemoperitoneum, secondary to ruptured corpus luteum Early diagnosis and reversal of anticoagulation can be lifesaving in this condition which carries significant mortality Unlike ruptured ectopic, ruptured corpus luteum causing haemoperitoneum due to warfarin induced coagulopathy can be managed conservatively, as bleeding stops after reversal of anticoagulation. However a strict continuous monitoring of hemodynamic status and hematology investigations in high dependency unit is required. A heightened awareness of these cases is required due to paucity of available reported literature.