# Isolated Ovarian Cyst Rupture Causing Hemoperitoneum After High-Energy Blunt Abdominal Trauma: A Case Report

## TL;DR

A rare case of a ruptured ovarian cyst causing severe internal bleeding after a high-impact fall is reported, emphasizing the need to consider gynecological causes in trauma evaluations.

## Contribution

Highlights the rare but critical possibility of isolated ovarian cyst rupture as a cause of hemoperitoneum in trauma patients.

## Key findings

- A 23-year-old woman with pelvic fractures had hemoperitoneum due to a ruptured ovarian cyst, not solid organ injury.
- Hemostasis was achieved without removing the ovary, preserving fertility.
- Gynecological causes should be considered in trauma patients without solid organ injury.

## Abstract

Hemoperitoneum after high-energy blunt abdominal trauma is most commonly caused by solid organ injuries, particularly involving the liver and spleen, while isolated gynecological sources are rare and may be overlooked during initial evaluation. We report the case of a 23-year-old woman who presented after a fall from the fourth floor with hemodynamic instability and signs of an acute abdomen. Imaging revealed massive hemoperitoneum without evidence of solid organ injury, along with extensive pelvic fractures. Emergency exploratory laparotomy was performed due to persistent instability, and no general surgical source of bleeding was identified; instead, the sole cause of hemorrhage was a ruptured 12-cm ovarian cyst. Hemostasis was achieved through local hemostatic suturing while preserving the ovarian parenchyma. The postoperative course was uneventful. This case highlights that isolated ovarian cyst rupture, although rare, may represent the sole source of life-threatening hemoperitoneum following high-energy blunt abdominal trauma. In women of reproductive age, gynecological causes should be considered when no solid organ injury is identified, and exclusion of urological injury in the presence of pelvic fractures may facilitate focused and timely surgical management.