When a patient is receiving anticoagulant therapy, the rupture of a corpus luteum cyst may go unrecognized in healthy women but becomes clinically relevant as it might exacerbate a hemoperitoneum episode. This report describes the case of a 26-year-old primipara who underwent surgical treatment for a heart defect and later experienced extensive hemoperitoneum. The patient reported to the casualty with symptoms of unstable hemodynamic status such as hypotension 90/60 mmHg and tachycardia 120 beats/minute. A multidisciplinary team decided upon surgical management after stabilizing the coagulation profile and correcting the shock with blood and blood products. The reason was discovered to be a ruptured cyst wall, which was fixed electrosurgically. The patient had a full recovery with no postoperative complications. The most noteworthy aspect of this case was the catastrophic hemoperitoneum caused by improper anticoagulant treatment monitoring. Management of such cases depends on the age of the patient, fertility, and calculating the long-term prognosis of the anticoagulation therapy for the patient.

This case investigates the difference between heterotopic pregnancy vs. intrauterine pregnancy, a topic that more emergency medicine physicians will face as the rates of assisted reproductive technologies increase. Throughout the case, the pathognomonic \"Ring of Fire\" is discussed, as is seen on the transvaginal ultrasound, and its reliability is assessed.

BACKGROUND: This study aimed to evaluate the incidence and risk factors of adnexal torsion (AT) in the Korean population from 2009 to 2018 (10 years).
METHODS: We analyzed the 2009-2018 data obtained from the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. AT was identified by both diagnosis codes and surgery codes of adnexal surgery.
RESULTS: A total of 6,262,910 women were recorded in the database. The incidence of AT was 6 per 100,000 women (95% confidence interval (CI), 6-6). The incidence of AT tended to decrease with age after peaking in the late 20s to early 30s. In the weighted logistic regression analysis, women of childbearing age, especially in their 20s and 30s, had the highest AT incidence. Corpus luteal cyst (p < 0.001) and benign neoplasm (p < 0.001) increased the incidence of AT. Low socioeconomic status (SES), Charlson comorbidity index (CCI), and pregnancy were unrelated to AT.
CONCLUSIONS: The incidence of AT is 6 per 100,000 women and peaks in the 20s to early 30s.

A 47 year old patient with a G3, FIGO stage 1A endometrial cancer was treated by hysterectomy. Her two ovaries were conserved because of the pre-operative diagnosis of endocervical cancer. On follow up PET-CT follow up investigation, she had a benign ovarian corpus luteal cyst mistaken as a metastatic pelvic lymph node which was later removed and proven benign histologically. This paper is to raise the clinical awareness of possible false positive PET finding from a benign ovarian cyst, such that a misinterpretation of \"recurrence\" as in this case can be avoided.

Ovarian pregnancy is a rare event occurring in 1-3% of all ectopic pregnancies. Increased reporting might be due to the wider use of intra-uterine devices, ovulatory drugs and assisted reproductive techniques. Though ovarian pregnancy has a distinct pathology, it can be a source of clinical and intraoperative diagnostic difficulty. We report two cases of ovarian pregnancy - one primary and one secondary - that came to our notice within six months span. Unlike tubal ectopic and secondary ovarian pregnancies, patients with primary ovarian pregnancy are likely to experience success in future intra-uterine conception and negligible risk.