A Rare Case of a Large Ovarian Endometrioma Presenting as a Hypertensive Emergency

Endometriosis, a common gynecological condition in reproductive-aged women presents with symptoms such as pelvic pain, menorrhagia, dysmenorrhea, dyspareunia, and infertility. Endometriomas are a form of endometriosis, characterized by cystic masses most commonly found on the ovaries. It impacts roughly 10% of women in the world who are at reproductive age. This report details a rare case of a 25-cm endometrioma in a 20-year-old woman who presented with acute abdominal pain and a hypertensive emergency due to renal perfusion issues.

The patient arrived at the emergency department with severe abdominal pain and high blood pressure (190/121). Her physical examination revealed a distended abdomen with palpable firmness, moderate tenderness, and guarding. Her other medical history was insignificant except for a history of chronic constipation and bloating for several months.

Imaging revealed a large cystic mass causing bilateral hydroureteronephrosis, leading to acute kidney injury. She underwent minimally invasive surgery for cyst removal and a salpingo-oophorectomy, which resolved her symptoms and normalized her blood pressure without postoperative complications.

This case highlighted the atypical presentation of a large endometrioma without prior diagnosis, leading to an acute hypertensive emergency, which is rare. Factors contributing to hypertension included severe pain and the mass effect of the cyst on renal vasculature. Following surgical intervention, the patient remained asymptomatic and was able to conceive within a year, underscoring the importance of a multidisciplinary approach to managing endometriosis.

Source: Vishwanath V, Marchand G, Azadi A. Large Endometrioma That Triggered a Hypertensive Emergency: A Case Report. Case Rep Obstet Gynecol. 2024 Oct 23;2024:7869172. doi: 10.1155/2024/7869172. PMID: 39479462; PMCID: PMC11524699.