Adnexal Lesion with Hemoperitoneum in a Woman of Reproductive Age: Beyond Ectopic Gestation

Non traumatic hemoperitoneum can either occur spontaneously or it can be iatrogenic. Presenting complaints of the patients can range from minor abdominal pain to intestinal obstruction. We report one such case of hemoperitoneum occuring in a young female, who was found to have a complex solid cystic adnexal lesion on initial imaging. Based on last menstrual period, urine pregnancy test and imaging findings, the diagnosis of ruptured ectopic pregnancy was ruled out. Further evaluation revealed prosthetic heart valves and history of anti - coagulation therapy for 3years with deranged coagulation profile. The patient was managed conservatively. The anti - coagulation therapy was withheld and fresh frozen plasma was transfused. The clinical condition of patient improved with reduction in the size of adnexal lesion and near complete resolution of fluid from abdomen. This case emphasizes that at times radiologists may be the first set of clinicians to diagnose a hemoperitoneum and exclude the possibility of hemoperitoneum due to anticoagulation in the appropriate clinical setting, so that they can alert their clinical colleagues.