Highlight RG Pitampura expertly managed a rare, complex gynecologic emergency involving
extensive internal bleeding and adhesions, preserving fertility and facilitating a smooth recovery
through minimally invasive laparoscopic surgery.

RG Pitampura has reinforced its leadership in minimally
invasive gynaecologic care with the successful management of a rare and complex case
involving ruptured bilateral ovarian endometriotic (chocolate) cysts with haemoperitoneum
and hemorrhagic shock.

A 32-year-old unmarried female presented to the emergency department with severe
abdominal pain and nausea that had persisted and worsened over two days. Upon admission,
she exhibited dyspnoea, tachycardia, and acute abdominal tenderness. Diagnostic
investigations revealed ruptured bilateral ovarian endometriotic cysts accompanied by massive
internal bleeding (approximately 1.5 litres) and hemorrhagic shock.

Under the expert care of Dr. Richa Arora Miglani, Head – Minimally Invasive Gynaecology &
Robotic Surgery, RG Pitampura, the patient underwent an emergency laparoscopic procedure.
Intraoperative findings revealed a ruptured right ovarian endometriotic cyst measuring 15 × 12
cm and a left ovarian endometriotic cyst measuring 6 × 5 cm, with dense omental and bowel
adhesions completely obliterating the pouch of Douglas. Endometriotic deposits were also
observed extending up to the liver surface.

Dr. Miglani and her team performed laparoscopic excision of bilateral chocolate cysts,
peritoneal lavage, adhesiolysis, and right ovarian reconstruction, successfully preserving both
ovaries to maintain the patient’s future fertility potential. The postoperative period was smooth
and uneventful, with the patient making a full recovery and being discharged in satisfactory
condition.

“This case was particularly challenging due to the extent of adhesions and the severity of
internal bleeding. Through timely diagnosis and advanced laparoscopic intervention, we
were able to manage the condition effectively while preserving the patient’s reproductive
potential,” added Dr. Richa Arora Miglani.

This rare and complex case highlights RG Pitampura’s commitment to excellence in minimally
invasive and fertility-preserving gynaecologic surgeries, supported by advanced technology
and multidisciplinary expertise.