A CASE REPORT:

OVARIAN APOPLEXY AND ECTOPIC

PREGNANCY AT ONCE
Mochammad Imam Santoso1, Sutan Chandra2
1General practitioner in H.L. Manambai Abdulkadir West Nusa Tenggara
Provincial Hospital, Sumbawa
2Obstetrics and Gynecologist in H.L. Manambai Abdulkadir West Nusa
Tenggara Provincial Hospital, Sumbawa.
 Introduction
 Ovarian Apoplexy is the sudden
rupture of the ovarium that
commonly occured at the cite of
corpus luteum cyst, followed by
hemoperitoneum.
 The increased vascularity of the
ovary in the luteal phase may
predispose to rupture of the cyst
resulting acute abdomen and
hemoperitoneum.
 Hemoperitoneum secondary to
rupture of the cyst exceedingly
rare, but potentially life-
threatening presentation, with
few cases reported in the
literature.
 Brisk and accurate evaluation
of acute abdomen is always a
priority because of the
potential need for emergency
surgical intervention.
 The major differential
diagnosis of the ovarian
apoplexy in reproductive age
woman is ectopic pregnancy,
but there is no reported cases
it occurs concomitantly with
ovarian apoplexy.
 This could possibly be the
first such report.
Case Presentation
CHIEF COMPLAINT: Vaginal
spotting
 26 Years old woman with
history of abortion in her first
pregnancy came to
emergency room with 3 days
history of vaginal spotting
and mild continous right lower
abdominal pain.
 She was suspected as
incomplete abortion from
primary health care. She was
in 6 weeks delaying menstrual
period which is uncommon
case for incomplete abortion.
 Physical exam within normal
limit with no hypovolemic sign.
 Pelvic exam was perform with
mild pain in the right lower
pelvic. Her pain score was 2
from 10. She was annoyed by
the vaginal spotting rather
than the pain. No lower
abdominal tenderness or any
defans.
 Her laboratorium result also
normal. Pregnancy test was
positive (second pregnancy).
 Pelvic ultrasound was
performed and found
right adnexal complex
mass with free fluid
was filling the Douglasi
pouch
 Surgery was
performed after
completed the consent.
 Approximately 500
mls of intraabdominal
blood was identified
during abdominal
exploration.
 Exploring the right
ovarian, there was a
ruptured corpus luteum
cyst causing rupture of
ovarian edge with
active bleeding.
 It was found to be the
source of the intra-
abdominal
hemmorrhage.
 The hemmorhage simply
stopped by
electrocauterization.
 There was an unruptured pars
isthmica right fallopian tube
pregnancy and also no any blood
spilled from the tube.
 The tube pregnancy was removed
by total salphingectomy procedure
because it located at the pars
isthmica fallopian tube.
 Left tube is patent. Left ovarian is
normal.
 Patient was discharged 48 hours
after surgery with no any
complications. During surgery
recovery she experienced no pain
on her surgery wound in standard
analgetic (Paracetamol).
Discussion
 Ovarian Apoplexy concomitantly occurs with ectopic
pregnancy has not been reported before.
 Clinical signs and symptoms especially pain perception
of acute abdomen in person who has high tolerance of
pain may bias the diagnosis.
 Massive hemoperitoneum resulting from an ovarian
apoplexy is potentially life-threatening if it not
diagnosed and treated with undergoes surgical
treatment emergently.

Keywords:
Ovarian apoplexy, ectopic pregnancy, pain tolerance.