Approach Considerations

Patients with presumed cyst rupture are typically managed conservatively. Conservative medical care may consist of outpatient treatment with oral analgesics in the stable patient, or if the clinical picture is evolving, admission and anticipatory management with serial abdominal examinations and laboratory testing, repeat imaging, and pain relief with an analgesic of choice.^[20]Medications may range from oral acetaminophen to intravenous morphine via patient-controlled analgesia (PCA) infusion pumps. If continued bleeding is a concern or if the patient is unstable hemodynamically, proceed with surgery.^[20]

Surgical care may entail laparoscopy or laparotomy, depending on clinical presentation, amount of blood in the abdomen, patient stability, and operator skill.^{[21, 22]}Most bleeding can be stopped with suturing, cautery, cystectomy, or wedge resection. Occasionally, salpingo-oophorectomy is necessary.

For the patient with multiple episodes of ruptured physiologic cysts or following a single severe episode, it is reasonable to consider suppression of ovulation with oral hormonal contraception, as this may help reduce the risk of recurrence of ovarian cysts.^[23]

Medication

Sivanesaratnam V, Singh A, Rachagan SP. Intraperitoneal haemorrhage from a ruptured corpus luteum. A cause of "acute abdomen" in women. Med J Aust. 1986 Apr 14. 144(8):411, 413-4. [QxMD MEDLINE Link].
Mohamed M, Al-Ramahi G, McCann M. Postcoital hemoperitoneum caused by ruptured corpus luteal cyst: a hidden etiology. J Surg Case Rep. 2015 Oct 1. 2015 (10):[QxMD MEDLINE Link].
Suh DS, Han SE, Yun KY, Lee NK, Kim KH, Yoon MS. Ruptured hemorrhagic corpus luteum cyst in an undescended ovary: a rare cause of acute abdomen. J Pediatr Adolesc Gynecol. 2015 Sep 25. [QxMD MEDLINE Link].
Kim JH, Jeong SY, Cho DH. Massive hemoperitoneum due to a ruptured corpus luteum cyst in a patient with congenital hypofibrinogenemia. Obstet Gynecol Sci. 2015 Sep. 58 (5):427-30. [QxMD MEDLINE Link].
Muller CH, Zimmermann K, Bettex HJ. Near-fatal intra-abdominal bleeding from a ruptured follicle during thrombolytic therapy. Lancet. 1996 Jun 15. 347(9016):1697. [QxMD MEDLINE Link].
Gupta N, Dadhwal V, Deka D, Jain SK, Mittal S. Corpus luteum hemorrhage: rare complication of congenital and acquired coagulation abnormalities. J Obstet Gynaecol Res. 2007 Jun. 33(3):376-80. [QxMD MEDLINE Link].
Agboola AA, Uddin K, Taj S, et al. Dermoid Cyst Spillage Resulting in Chemical Peritonitis: A Case Report and Literature Review. Cureus. 2022 Sep. 14 (9):e29151. [QxMD MEDLINE Link]. [Full Text].
Mantecon O, George A, DeGeorge C, et al. A Case of Hemorrhagic Ovarian Cyst Rupture Necessitating Surgical Intervention. Cureus. 2022 Sep. 14 (9):e29350. [QxMD MEDLINE Link]. [Full Text].
Li RY, Nikam Y, Kapurubandara S. Spontaneously Ruptured Dermoid Cysts and Their Potential Complications: A Review of the Literature with a Case Report. Case Rep Obstet Gynecol. 2020. 2020:6591280. [QxMD MEDLINE Link]. [Full Text].
Tang LC, Cho HK, Chan SY. Dextropreponderance of corpus luteum rupture. A clinical study. J Reprod Med. 1985 Oct. 30(10):764-8. [QxMD MEDLINE Link].
Shiota M, Kotani Y, Umemoto M, et al. Preoperative differentiation between tumor-related ovarian torsion and rupture of ovarian cyst preoperatively diagnosed as benign: a retrospective study. J Obstet Gynaecol Res. 2013 Jan. 39(1):326-9. [QxMD MEDLINE Link].
Tanaka K, Kobayashi Y, Dozono K, et al. Elevation of plasma D-dimer levels associated with rupture of ovarian endometriotic cysts. Taiwan J Obstet Gynecol. 2015 Jun. 54 (3):294-6. [QxMD MEDLINE Link].
Mohamed M, Al-Ramahi G, McCann M. Postcoital hemoperitoneum caused by ruptured corpus luteal cyst: a hidden etiology. J Surg Case Rep. 2015 Oct 1. 2015 (10):[QxMD MEDLINE Link].
Jain KA. Sonographic spectrum of hemorrhagic ovarian cysts. J Ultrasound Med. 2002 Aug. 21(8):879-86. [QxMD MEDLINE Link].
Sickler GK, Chen PC, Dubinsky TJ, Maklad N. Free echogenic pelvic fluid: correlation with hemoperitoneum. J Ultrasound Med. 1998 Jul. 17(7):431-5. [QxMD MEDLINE Link].
Friedrich L, Meyer R, Levin G. Management of adnexal mass: A comparison of five national guidelines. Eur J Obstet Gynecol Reprod Biol. 2021 Oct. 265:80-9. [QxMD MEDLINE Link].
Choi NJ, Rha SE, Jung SE, et al. Ruptured endometrial cysts as a rare cause of acute pelvic pain: can we differentiate them from ruptured corpus luteal cysts on CT scan?. J Comput Assist Tomogr. 2011 Jul-Aug. 35(4):454-8. [QxMD MEDLINE Link].
Borders RJ, Breiman RS, Yeh BM, Qayyum A, Coakley FV. Computed tomography of corpus luteal cysts. J Comput Assist Tomogr. 2004 May-Jun. 28(3):340-2. [QxMD MEDLINE Link].
Liu X, Song L, Wang J, Liu Q, Liu Y, Zhang X. Diagnostic utility of CT in differentiating between ruptured ovarian corpus luteal cyst and ruptured ectopic pregnancy with hemorrhage. J Ovarian Res. 2018 Jan 9. 11 (1):5. [QxMD MEDLINE Link].
Raziel A, Ron-El R, Pansky M. Current management of ruptured corpus luteum. Eur J Obstet Gynecol Reprod Biol. 1993 Jun. 50(1):77-81. [QxMD MEDLINE Link].
Teng SW, Tseng JY, Chang CK, Li CT, Chen YJ, Wang PH. Comparison of laparoscopy and laparotomy in managing hemodynamically stable patients with ruptured corpus luteum with hemoperitoneum. J Am Assoc Gynecol Laparosc. 2003 Nov. 10(4):474-7. [QxMD MEDLINE Link].
Odejinmi F, Sangrithi M, Olowu O. Operative laparoscopy as the mainstay method in management of hemodynamically unstable patients with ectopic pregnancy. J Minim Invasive Gynecol. 2011 Mar-Apr. 18(2):179-83. [QxMD MEDLINE Link].
Christensen JT, Boldsen JL, Westergaard JG. Functional ovarian cysts in premenopausal and gynecologically healthy women. Contraception. 2002 Sep. 66(3):153-7. [QxMD MEDLINE Link].
Bannon LC, Hayes KG, Porter KB. Percutaneous drainage of a rapidly enlarging simple ovarian cyst in the third trimester. Mil Med. 2015 Oct. 180 (10):e1118-20. [QxMD MEDLINE Link].

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Author

Charles Nathan Webb, MD, MS Assistant Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Charles Nathan Webb, MD, MS is a member of the following medical societies: AAGL, American College of Obstetricians and Gynecologists, American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

Additional Contributors

David Chelmow, MD Leo J Dunn Professor and Chair, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Council of University Chairs of Obstetrics and Gynecology, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society, Society for Academic Specialists in General Obstetrics and Gynecology, Society for Reproductive Investigation

Disclosure: Nothing to disclose.

Richard Scott Lucidi, MD, FACOG Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD, FACOG is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Charles J Ascher-Walsh, MD Director of Gynecology, Female Pelvic Medicine and Reconstructive Surgery, Mt Sinai School of Medicine; Clinical Assistant Professor, Department of Obstetrics and Gynecology, Mt Sinai Medical Center

Charles J Ascher-Walsh, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Obstetricians and Gynecologists, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Richard S Legro, MD Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center

Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons

Disclosure: Korea National Institute of Health and National Institute of Health (Bethesda, MD) Honoraria Speaking and teaching; Greater Toronto Area Reproductive Medicine Society (Toronto, ON, CA) Honoraria Speaking and teaching; American College of Obstetrics and Gynecologists (Washington, DC) Honoraria Speaking and teaching; National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Think Tank Panel (Bethesda, MD) Honoraria Speaking and teaching; University of Illinois (Chicago, IL) Honoraria Speaking and teaching; Georgetown University Hospital (Washington, DC) Honoraria Speaking and teaching; Heilongjiang University (Harbin, China) Speaking and teaching; New England Fertility Society (Nashua, NJ) Honoraria Speaking and teaching; William Beaumont Hospital Division of Reproductive Endocrinology and Infertility (Detroit, MI) Honoraria Speaking and teaching; Wayne State University School of Medicine (Detroit MI) Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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