Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access
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Case Report

Volume 9, Number 4, December 2020, pages 112-118

Successful Conservative Treatment of Ovulation-Related Hemoperitoneum in a Patient With Congenital Hypofibrinogenemia: A Case Report and Review of Literature

Figures

Figure 1.
Figure 1. Transvaginal ultrasound at admission showing the massive hemoperitoneum and the two ovarian cysts.
Figure 2.
Figure 2. Timetable of coagulation profile. FFP: fresh frozen plasma; INR: international normalized ratio; PT: prothrombin time; aPTT: activated partial thromboplastin time.
Figure 3.
Figure 3. Transvaginal ultrasound showing the progression of the hemoperitoneum. (a) On day 2, (b) day 4, (c) day 6 of admission. (d) 4 days after discharge.

Table

Table 1. Cases of Hemoperitoneum due to Ovulation or Corpus Luteal Rupture in Patients With Fibrinogen Deficiency
 
StudiesDisorderAgePrevious clinical presentationCurrent clinical presentationMedical treatmentSurgery intervention
CL: corpus luteum; CLCH: corpus luteum corpus hemorrhagicum; SC: subcutaneous; OCPs: oral contraceptive pills; FFP: fresh frozen plasma; pRBCs: packed red blood cells.
Schneider et al, 1981 [6]Afibrinogenemia/1 current episode22Sp.Spl.Rupt + SC hematomaHemoperitoneum/CLCH3 FFPs + 4 units cryoprecipitate; failed to stop bleedingLaparotomy + oophorectomy
Bottini et al, 1991 [7] case 3Afibrinogenemia/1 current episode22Bleeding/post-op, post-trauma, spontaneous and menorrhagiaHemoperitoneum/CLCH5 g fibrinogen before surgery failed OCPs prevented recurrence on long-term follow-upLaparotomy + wedge resection of ovary
Castaman et al, 1995 [8]Afibrinogenemia/2 previous episodes24Omphalorrhagia + spontaneous hemarthrosis + hemoperitoneum/CLCH × 2 episodes 2 years apartNo recurrencesOCPs prevented recurrencePrevious 2 × Laparotomy + wedge resection of both ovaries on two occasions soon after menarche
Henselmans et al, 1999 [9]Afibrinogenemia /1 current episode21Ovulation-related hypovolemic shockIntracranial hemorrhage + pulmonary emboliOCPs prevented ovulation related bleedPrevious laparotomy to control bleeding
Koussi et al, 2001 [10]Afibrinogenemia/1 current episode14Cephalhematoma + epistaxis + gum bleed + menorrhagiaHemoperitoneum/CLCHpRBCs × 3 + cryoprecipitate × 12 units; successfulNo surgical intervention needed
Cetinkaya et al, 2010 [1]Afibrinogenemia/2 episodes/3 months apart24Hemoperitoneum/ ovulationCurrent episode Hemoperitoneum/ovulationpRBCs × 2; FFPs × 6; successful in the second episodePrevious laparotomy to control bleeding
Ozdemir et al, 2014 [11]Afibrinogenemia/5 episodes28spontaneous abortion + 5 × hemoperitoneum/ovulationCurrent episode Hemoperitoneum/CLCHpRBCs × 2; FFPs × 16; cryoprecipitate × 5; successful in 3 episodes but failed in 2 episodes1: expectant ttt; 2: laparotomy right ovary cystectomy; 3: expectant ttt; 4: laparotomy right oophorectomy; 5: expectant ttt
Kim et al, 2015 [12]Hypofibrinogenemia/1 current episode18Childhood epistaxisHemoperitoneum/CLCHpRBCs × 3 + FFPs × 6; failed to stop bleedLaparoscopic coagulation of CL bleeding site
Ramadan et al, 2020Hypofibrinogenemia/1 current episode26Bleed at tooth extraction at age 9Hemoperitoneum/ovulationpRBCs × 3 + FFPs × 10; successfulNo surgical intervention needed