Integrating ultrasound findings and extreme CA-125 elevation in the diagnosis of spontaneous endometrioma rupture: a case report

Introduction: Spontaneous rupture of an endometrioma may result in life-threatening condition. Detection and prompt treatment are necessary. Presentation of Case: A 27-year-old woman presented to labor and delivery unit with acute abdominal pain that had present for 1 day and was coinciding with the first day of menses. Ultrasonography demonstrated a unilocular cyst mass with internal echoes with a ground glass appearance, consistent with endometrioma. The cyst wall was irregular, with features of collapse. Free fluid was present in the abdominal cavity with an echogenicity similar to the cyst content. CA-125 was 5315 U/ml, C-reactive protein 96.8 mg/L, procalcitonin 1 ng/ml. Intraoperatively, a 10-cm cyst was identified in the left ovary, adherent to the posterior uterine corpus and rectum. We performed a laparotomy cystectomy and peritoneal lavage. Final histopathology result confirmed a diagnosis of endometriosis. Discussion: Elevated CA-125 levels were attributed to the rupture of a large endometrioma leading to diffuse peritonitis with resulting elevation of CA-125. Similar findings of markedly raised CA-125 have been documented in other reports of ruptured endometriomas. Conclusion: This case provides valuable insight into the use of ultrasound and CA-125 in the diagnosis of a ruptured endometrioma.