Deep Infiltrating Endometriosis and Spontaneous Hemoperitoneum: A Life-Threatening Situation Treated by Laparoscopy

Objective: To describe a case of spontaneous hemoperitoneum in a woman affected by deep infiltrating endometriosis (DIE). Design: Technical video showing laparoscopic management of a spontaneous hemoperitoneum in a patient with DIE. Setting: Minimally Invasive Gynecological Unit, Sant'Orsola Academic Hospital, Bologna, Italy. Intervention: A 35-year-old nulliparous woman was admitted to our gynecologic emergency room because of pelvic pain and a fainting sensation. She had a history of DIE and had been followed for 6 months by our outpatient clinics. The patient underwent an immediate laparoscopy because of the rapid worsening of clinical conditions. After blood suction and difficult adhesiolysis, a vascular lesion with a huge blood flow, close to the left utero-ovarian ligament, was detected. Selective coagulation was performed with good results. During the follow-up visit after 1 month, the patient reported good health. Written informed consent was obtained from the patient for publication of this case report. Conclusion: Spontaneous hemoperitoneum represents a rare and life-threatening complication associated with endometriosis. In patients with hemoperitoneum and a history of endometriosis, it is important to pay attention to the possible presence of uncommon bleeding localizations. Laparoscopy was useful and effective in this challenging situation, identifying the bleeding source and performing selective coagulation.