Hemoperitoneum associated with Coitus during Ovulation

Introduction: Acute abdominal pain with hemoperitoneum is a common gynecological emergency. In childbearing age women, the commonest causes need to be ruled out include ectopic pregnancy and ruptured corpus luteal cyst. Acute abdomen with hemoperitoneum due to ovulation bleed is almost unheard of and rare. Even more uncommon are ovulation bleed associated with non vigorous sexual intercourse with no evidence of vaginal trauma or injury. Case reports: We presented 2 cases of women aged 29 and 33 years old presented to emergency department Sultan Ahmad Shah Medical Centre (SASMEC)@IUM with acute abdominal pain preceded by sexual intercourse at mid menstrual cycle. Interestingly, 1 of them had similar presentation prior within the same year whereby she had undergone emergency laparotomy and cystectomy for ruptured hemorrhagic cyst with hemoperitoneum in a nearby hospital during which she required transfusions. However, in our cases, both women remained hemodynamically stable and were treated conservatively.Diagnosis of ovulation bleed is likely if patient is in luteal phase that coinciding sexual intercourse which increases risk of excessive bleeding due to vasocongestion together with acceleration-deceleration force that increases intraluminal pressure during coitus may also predispose to injury. The main targets in treatment are to eliminate bleeding source while preserving ovarian function. Surgical approach has always been method of management, however if pain resolved, patient's hemodynamic and hematological status remained stable, conservative approach should be considered as an option. Conclusion: Therefore, ovulation bleed causing hemoperitoneum should be considered in childbearing age women same as ectopic pregnancy and ruptured corpus luteal cyst. Getting proper menstrual cycle history is mandatory and history of prior sexual intercourse should alert the gynecologist. Management will be based on hemodynamic stability of patient