title: Laparoscopic internal iliac artery ligation for postpartum spontaneous hemoperitoneum.
abstract: BACKGROUND
  Spontaneous hemoperitoneum in pregnancy or the postpartum period is an uncommon but potentially life-threatening complication.
  
  
  METHODS
  A 29-year-old woman presented with severe abdominal pain, decreased consciousness, and a reduced hemoglobin level three days after an uneventful spontaneous vaginal delivery. Initial ultrasound and CT imaging showed significant hemoperitoneum with no identifiable cause. Laparoscopic surgery was performed, during which bleeding from the left uterine artery was identified and resolved with laparoscopic internal iliac artery ligation. Concomitant cul-de-sac obliteration and adhesions secondary to decidualized endometriosis were found.
  
  
  CONCLUSIONS
  Decidualized endometriosis is a possible etiologic factor in spontaneous hemoperitoneum. Prompt diagnosis and treatment are critical for improving outcomes. When surgical intervention is indicated, a laparoscopic approach should be considered because of its minimally invasive nature and shorter recovery time.
authors.affiliation: School of Medicine, Queen's University, Kingston ON.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lu Gao
authors.affiliation: Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON.
authors.forename: Karine
authors.initials: K
authors.lastname: Lortie
authors.affiliation: Department of Obstetrics and Gynecology, The Ottawa Hospital, University of Ottawa, Ottawa ON.
authors.forename: Sukhbir Sony
authors.initials: SS
authors.lastname: Singh
mesh_terms: D000328:Adult; D004312:Douglas' Pouch / Q000473:pathology; D004715:Endometriosis / Q000150:complications / Q000473:pathology; D005260:Female; D006465:Hemoperitoneum / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation; D010532:Peritoneal Diseases / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome