CURRENT MANAGEMENT OF RUPTURED CORPUS-LUTEUM

The objectives of the study are to assess current management of the ra ther frequent event of ruptured corpus luteum. Special emphasis is mad e on the value of ultrasonography, laparoscopy and culdocentesis in de ciding appropriate treatment. A series of 70 patients with ruptured co rpus luteum diagnosed and treated during a period of 6 years in one in stitution in Israel is reported. Eighteen patients with concurrent rup tured corpus luteum and ectopic pregnancy are included. Abdominal pain , the most prevalent presenting symptom, has no typical characteristic s. The correlation between large amount of fluid as observed by ultras ound and the finding of > 250 ml of blood at laparotomy is very high. Culdocentesis was performed in only 21 patients. Surgical intervention (laparoscopy, laparotomy following laparoscopy or direct laparotomy) was carried out in 58 patients (83%). The remaining 12 cases were hand led by observation only. Forty patients required laparotomy in whom 17 underwent wedge resection. We conclude that observation is sufficient treatment in hemodynamically stable patients, without severe abdomina l pain and in the presence of a small amount of pelvic fluid demonstra ted by ultrasound. When a large amount of fluid is observed and/or in the presence of severe abdominal pain laparoscopy should be performed on admission. Direct laparotomy is mandatory in case of circulatory co llapse.