Ruptured Ovarian Cyst Leading to Massive Spontaneous Intraperitoneal Hemorrhage in Chronic Immune Thrombocytopenic Purpura (ITP): Successful Nonsurgical Intervention

Immune thrombocytopenic purpura (ITP) patients typically exhibit mild mucocutaneous bleeding. Although corpus luteum hemorrhage (CLH) is usually asymptomatic, it can rarely result in serious intraperitoneal bleeding, usually in patients with coagulation abnormalities. In cases of severe thrombocytopenia, hemoperitoneum during ovulation during an ITP flare-up is an extremely unusual and potentially fatal event. Our patient, a 25-year-old multiparous female with a known case of ITP, presented with a spontaneous petechial rash all over the body, abdominal pain, and dizzy spells. Hemoglobin was 6.3 g/L with a platelet count of 0.04 × 10⁹/L and a negative urine pregnancy test. An abdominopelvic ultrasound revealed free fluid in the peritoneal cavity, and a contrast-enhanced computed tomography (CECT) confirmed hemoperitoneum with a ruptured ovarian cyst. We report the case of a young female with ITP relapse who landed into massive intraperitoneal hemorrhage and was managed conservatively with platelet transfusion, steroids, and romiplostim.