Cases reported "Rupture, Spontaneous"

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1/6. ovarian hyperstimulation syndrome complicated by peritonitis due to perforated appendicitis.

    We describe a case of ovarian hyperstimulation syndrome (OHSS) complicated by peritonitis due to perforated appendicitis. A 29-year-old woman presented with abdominal distension after ovarian stimulation with HMG followed by ovulation induction with HCG. Massive ascites with swollen ovaries was observed on ultrasound, and she was admitted on the diagnosis of OHSS. Daily infusion of serum albumin and low dose dopamine failed to increase her urine output and her abdominal symptoms became increasingly deteriorated after her urine pregnancy test turned out to be positive. paracentesis performed for alleviation of her abdominal distension revealed infected, foul-smelling fluid. An emergency laparotomy was performed, and the definite diagnosis was made as panperitonitis due to perforated appendicitis with right tubal pregnancy. appendectomy, right tubectomy and vigorous irrigation with drainage were performed. The case implies that OHSS might not only mask typical manifestations of appendicitis, but could also compromise concurrent intraperitoneal infection.
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ranking = 1
keywords = ovulation
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2/6. Prevention of hemoperitoneum during ovulation by oral contraceptives in women with type III von Willebrand disease and afibrinogenemia. case reports.

    The follicle ruptures at the time of ovulation and fills with blood, forming a corpus hemorrhagicum. Minor bleeding from the follicle into the abdominal cavity may cause peritoneal irritation and, when it occurs in a patient with a defect of primary hemostasis, hemoperitoneum can occur. Von Willebrand disease and afibrinogenemia are two important bleeding disorders in which both primary hemostasis and coagulation are involved. Bleeding during ovulation is one major clinical complication in women with these disease. We have studied three patients with this hemorrhagic complication. Our data show that oral contraceptives are an effective way to avoid hemoperitoneum.
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ranking = 6
keywords = ovulation
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3/6. Heterotopic pregnancy after in vitro fertilization and ovulatory drugs.

    We report two cases of heterotopic pregnancy in women who were previously infertile. One of these patients conceived with the aid of ovulation stimulatory drugs, and the other from in vitro fertilization. In each case an ultrasound of the pelvis revealed a viable intrauterine pregnancy (twins in one case). Both patients presented in hypovolemic shock and required exploratory laparotomy. At the time of surgery a ruptured ectopic pregnancy with accompanying hemoperitoneum was found in each. Simultaneous ectopic and intrauterine pregnancy, though rare, should be suspected in patients who conceive with the aid of ovulatory drugs or in vitro fertilization.
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ranking = 1
keywords = ovulation
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4/6. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis.

    Of 27 women in the reproductive age group receiving continuous ambulatory peritoneal dialysis for more than 3 months, 4 of 7 who menstruated developed recurrent hemoperitoneum. Tubal ligation had been done in 3 of these 4 women. There were 37 episodes of hemoperitoneum; 22 occurred at midcycle and 15 with menstruation. One patient required repeated blood transfusion, but after oral anovulant therapy no further bleeding occurred and no transfusion was required. Two patients needed laparotomy: one for heavy intraperitoneal bleeding originating from a luteal cyst, and the other for severe lower abdominal pain from follicular and luteal cysts. Ultrasound examinations suggested the presence of small ovarian cysts in the two remaining patients. Recurrent midcycle hemoperitoneum in women on continuous ambulatory peritoneal dialysis may be triggered by ovulation and associated ovarian cyst formation. Suppression of ovulation should be considered.
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ranking = 2
keywords = ovulation
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5/6. Spontaneous conception and intrauterine pregnancy in a symptomatic missed abortion of ectopic pregnancy conceived in the previous cycle.

    We encountered a rare case of combined intrauterine and extrauterine pregnancy that occurred following separate spontaneous ovulations. A 33 year old woman visited our hospital with the chief complaint of abdominal pain on April 16, 1993. Her last menstruation was from March 23 for 6 days. However, the urinary human chorionic gonadotrophin (HCG) on April 19 was 1024 IU/l. Pelvic examination and ultrasonography indicated an extrauterine pregnancy, which was confirmed by laparotomy and histological identification of trophoblast cells. The urinary HCG concentration markedly decreased after the operation. However, the HCG level increased again on the fifth post-operative day, and a gestational sac (11 mm) was identified in the uterine cavity on the 11th post-operative day, indicating that this intrauterine pregnancy was established following spontaneous ovulation which occurred before the removal of the extrauterine pregnancy. This case indicates that a combined pregnancy can occur not only after simultaneous multiple ovulations but also after the separate spontaneous ovulations.
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ranking = 4
keywords = ovulation
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6/6. Massive intraperitoneal hemorrhage from ruptured corpus luteum during anticoagulant therapy.

    The unpredictability of hemorrhagic complications during anticoagulant therapy is well known. An unusual case of massive intraperitoneal hemorrhage from a ruptured corpus luteum during such therapy is presented. That this complication is uncommon may be because relatively few premenopausal women are placed on anticoagulant therapy. In addition, the most likely condition for which premenopausal women are given anticoagulants is thrombophlebitis associated with pregnancy and childbirth when ovulation is inhibited.
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ranking = 1
keywords = ovulation
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