A 26-year-old woman presents with sudden severe lower abdominal pain of 6 hours duration. She has a history of dysmenorrhea. Examination shows guarding and rigidity. Ultrasound shows free fluid in the peritoneal cavity and a collapsed right adnexal cyst of 6 cm. Laparoscopy reveals dark brown fluid in the pelvis. What is the most likely diagnosis?
- A Ruptured corpus luteum cyst
- B Ruptured endometrioma ✓
- C Torsion of dermoid cyst
- D Ectopic pregnancy
Correct answer: B. Ruptured endometrioma
Explanation
A collapsed chocolate cyst with free dark brown haemorrhagic fluid at laparoscopy in a young woman with dysmenorrhea indicates rupture of an endometrioma. Leakage of old blood causes chemical peritonitis with acute abdomen. A ruptured corpus luteum would not show a collapsed chronic cyst with dysmenorrhea history, torsion shows an enlarged torted adnexa rather than a collapsed one, and ectopic pregnancy is excluded by the characteristic brown fluid and known endometriotic cyst.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.