Conservative Management of Hemoperitoneum Due to a Ruptured Hemorrhagic Ovarian Cyst in Type 3 von Willebrand Disease

Hemoperitoneum secondary to a ruptured hemorrhagic ovarian cyst is usually a benign and self-limiting condition, but in women with type 3 von Willebrand disease (VWD), it may evolve into a severe and potentially life-threatening event due to the inability to achieve spontaneous hemostasis. We report a case of a 30-year-old woman with type 3 VWD who presented with acute pelvic pain and profound anemia. Transvaginal ultrasonography and MRI demonstrated a ruptured hemorrhagic ovarian cyst associated with a large hemoperitoneum. Despite the extent of bleeding, the patient remained hemodynamically stable and was managed conservatively. Treatment consisted of von Willebrand factor replacement, blood transfusion, analgesia, and close clinical and radiological monitoring. Her condition improved progressively, with normalization of hemoglobin levels, resolution of symptoms, and significant regression of the hemoperitoneum on follow-up imaging. No surgical intervention was required. Managing ovarian cyst rupture in severe VMD is particularly challenging, as surgical intervention carries substantial hemorrhagic risk. Conservative management, when supported by adequate hemostatic therapy, can be both safe and effective, preserving ovarian function and reducing perioperative morbidity. This case underscores the importance of individualized, multidisciplinary care to optimize management strategies in women with severe bleeding disorders.