Laparoscopic Management of Peritonitis Due to a Ruptured Ovarian Endometrioma with Extremely High Levels of Cancer Antigen-125 and Cancer Antigen-19-9

Background: An endometrioma is a common gynecologic condition, usually defined as a growth of endometrial tissue outside the uterine cavity. Rarely, an ovarian endometrioma can rupture spontaneously, while the clinical significance of serum cancer antigen (CA)-125 and CA-19-9 levels might be that they are indicators of the presence of that endometrioma. Case: A 23-year-old nulliparous woman had acute abdominal pain with peritonitis. Computed tomography showed a left ovarian mass ∼12 cm with fluid collection in the intra-abdominal cavity and thickening of the omentum. These findings appeared to be ovarian cancer with ascites and omental caking. The patient's CA-125 and CA-19-9 levels were 25,149 U/mL and 5379 U/mL, respectively. Results: A laparoscopic view showed a ruptured left ovarian endometrioma with diffused chocolate content over the surface of the liver, omentum, and intra-abdominal cavity. Laparoscopic enucleation of the left ovary, peritoneal irrigation, and adhesiolysis were performed. A pelvic mass score, such as a risk of malignancy index, could not be used to detect malignant ovarian cancer due to the patient's high levels of CA-125 and CA-19-9. Conclusions: High-combination CA-125 and CA-19-9 concentrations could indicate the presence of a ruptured endometrioma. Laparoscopy-performed by an experienced endoscopist-is an efficient procedure for confirming a diagnosis and operating safely to remove the mass.