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Abstract: The patient, Ms. Lin, came to our hospital with abdominal pain, vaginal bleeding, anal cramping and other discomforts after having sex during the luteal phase. Ultrasound of uterine adnexa suggested a mixed mass in the left adnexa. Luteal cyst and pelvic effusion were considered, and anti-inflammatory and hemostatic drugs were given immediately for conservative treatment, which was effective and surgery was avoided. The patient had such symptoms, which were considered to be caused by the rupture of the corpus luteum cyst and bleeding due to excessive sexual intercourse, with blood accumulating in the posterior fornix.
Basic information】Female, 29 years old
Disease Type】Luteinizing cyst, ruptured luteal cyst
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of consultation】June 2021
Treatment plan】Anti-inflammatory treatment (cefuroxime sodium for injection) + hemostatic treatment (tranexamic acid injection)
Treatment Period】6 days in hospital, regular review
Effectiveness of treatment] Effective hemostasis by medication, abdominal pain relieved, condition under control
I. Initial consultation
The patient, Ms. Lin, reported that she had two abortions and was married with no children. The last menstrual period was on May 24, 2021, which cleared in 6 days, similar to the usual menstrual period, and she had sexual intercourse with her husband in the evening of June 16. On the morning of June 17, accompanied by her husband, she went to the hospital. On gynecological examination, she had painful cervical lifting, a normal-sized uterus, and a 4-cm-sized mass in the left adnexal area with unclear borders and pressure pain.
II. Treatment history
He was admitted with a temperature of 36.8℃, pulse rate of 79 beats/min, respiration of 20 breaths/min, blood pressure of 92/61mmHg, clear, abdominal pressure and rebound pain, and abdominal muscle tension. The ultrasound of the uterine adnexa suggested a mixed mass in the left adnexa, which was considered a luteal cyst of 42×31 mm in size, with no significant abnormalities in the uterus and right adnexa, and the presence of pelvic fluid. Routine blood count showed leukocytes 12.47×10^9/L, neutrophil percentage 82.5%, and hemoglobin 112g/L.
We analyzed the patient’s condition and based on the medical history and examination results, we considered that the rupture of the left ovarian corpus luteum cyst caused by sexual intercourse led to bleeding, resulting in pelvic effusion and abdominal pain, but at present the patient’s vital signs were normal and there was not much pelvic effusion, so we considered that the bleeding was not much and could be treated conservatively with medication first, and then surgically if increased bleeding occurred during treatment. The patient agreed to conservative treatment after discussion with her husband, so she was given anti-inflammatory treatment with cefuroxime sodium for injection and hemostatic treatment with tranexamic acid injection.
III. Treatment effect
After 6 days of hospitalization, the patient’s vital signs were normal, no fever, abdominal pain was relieved, and the routine blood tests were repeated with leukocytes 9.87×10^9/L, neutrophil percentage 78.5%, and hemoglobin 111 g/L. Ultrasound of the uterine adnexa suggested a mixed mass in the left adnexa, considering a luteal cyst, 25×13 mm, and no obvious fluid in the pelvis. After anti-inflammatory and hemostatic treatment, the bleeding was controlled, the size of the corpus luteum cyst was reduced, the pelvic fluid was absorbed, and the abdominal pain was relieved, so she was discharged from the hospital and advised to continue outpatient medication and review.
IV. Notes
1. We are glad that the patient’s abdominal pain was relieved after treatment. After discharge, the patient is advised to take more rest, avoid strenuous exercise, eat lightly, observe for 1 week and then review blood routine and uterine adnexal ultrasound in outpatient clinic.
2, luteal cysts may appear in every menstrual cycle, so there is still a possibility of re-occurrence in the future, it is recommended that women avoid having intercourse too vigorously or performing strenuous exercise during the luteal phase to reduce its incidence.
3, luteal cysts are normal physiological cysts, generally will not affect fertility, patients do not worry too much. However, after the rupture of luteal cysts bleeding, pelvic blood may cause adhesions, so after the cure, we should exercise properly to reduce the occurrence of adhesions.
V. Personal insight
Luteal cysts are more common in the luteal phase, generally small in size, and with changes in hormone levels, will automatically subside, so most luteal cysts do not rupture, generally only after the cysts are large in size, and at the same time carry out sexual life too hard, strenuous exercise and other stimuli, rupture will occur, such as this case of patients. Once the above symptoms appear, it is important to seek medical attention early and give medication as soon as possible if there is not much bleeding, most patients can effectively stop bleeding and avoid surgery.