Objectives Present unusual case of acute hemoperitoneum in a patient with choriocarcinoma.
Methods A 22-year-old Para three (3) mother presented to the emergency outpatient clinic with one-month duration of vaginal bleeding. She had multiple visits at a regional hospital prior to referral for severe anemia and hemoptysis. At time of presentation she was acutely ill, hypotensive, tachycardic and hypoxic. On Ultrasound of the pelvis, there was large free fluid in the abdomen with an associated uterine mass. Laboratory evaluation revealed Hematocrit at 20% with serum Beta-hCG (Human chorionic gonadotropin) of 450,000 miu/ml. Patient was diagnosed with acute intra-abdominal bleeding.
Results At the time of laparotomy, she was diagnosed with 3 liters of hemoperitoneum and uterine rupture. There was fungating mass extending out of the uterus to the peritoneal cavity. A total abdominal hysterectomy was performed. Pathology diagnosis revealed choriocarcinoma. Patient was ultimately diagnosed with Stage IV choriocarcinoma with vagina/lung/brain metastasis and underwent treatment with multi-agent chemotherapy.
Conclusions Choriocarcinoma is a fatal gynecologic malignancy when undiagnosed and untreated. In resource limited settings delay to diagnosis leads to unusual clinical presentation with serious morbidity and mortality. Increased awareness about gestational trophoblastic neoplasia and access to high quality treatment is critical for cure.
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