A 30-year-old woman with known bilateral endometriomas presents on day 2 of her menstrual cycle with sudden, severe generalized abdominal pain, guarding and rebound tenderness. Pulse is 110/min and blood pressure 100/70 mmHg. Urine pregnancy test is negative. The MOST likely cause of this acute deterioration is:

• A Appendicitis
• B Acute salpingitis
• C Torsion of a paratubal cyst
• D Rupture of an endometrioma with chemical peritonitis ✓

Explanation

Rupture of a chocolate cyst releases dark tarry blood and inflammatory contents into the peritoneal cavity, producing sudden severe pain with peritonism, classically around menstruation when intracystic pressure peaks. In a patient with documented endometriomas and no fever, this presentation is characteristic. Acute salpingitis and appendicitis usually produce fever and a more subacute course. Paratubal cyst torsion is possible but far less likely given the established endometriotic disease, and management here is resuscitation followed by laparoscopic lavage and cystectomy.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.