Pregnancy luteoma presenting as ovarian torsion with rupture and intra-abdominal bleeding

 

ABSTRACT

We report a case of pregnancy luteoma, which had undergone torsion in a 33-year-old Indian woman, who presented with severe abdominal pain and decreasing haemoglobin levels at 33 weeks gestation. Ultrasonography showed a right adnexal mass, probably ovarian in origin, with suspicious intratumoral bleed. The pain was treated symptomatically, and the symptoms improved. A successful induction of labour was then performed at 36 weeks gestation. The pain recurred almost immediately after the delivery, and she experienced another intra-abdominal bleed. A diagnostic laparotomy and a right salpingo-oophorectomy were performed, and the diagnosis of luteoma was made based on histology. We discuss the clinical presentation of this unusual tumour, though often asymptomatic, can rarely present with severe abdominal pain from complications like torsion with rupture, leading to massive intra-abdominal bleeding. We also discuss the possible radiological investigations which can be done during pregnancy.

Keywords: intra-abdominal bleeding, ovarian torsion, pregnancy luteoma, pregnancy-associated tumours
Singapore Med J 2008; 49(3):e78-81