Ruptured giant hyperreactio luteinalis as a life-threatening complication of gestational trophoblastic disease

Abstract

Hyperreactio luteinalis (HL) is a benign ovarian condition characterized by the presence of multiple thecalutein cysts secondary to elevated levels of human chorionic gonadotropin (hCG); it is a rare complication of the post-molar period.

We present the case of a 33-year-old female patient who, four weeks after evacuation of a hydatidiform mole, was admitted with acute abdominal pain and severe hypovolemic shock. An emergency exploratory laparotomy was performed, revealing massive hemoperitoneum (3,000 mL) and rupture of bilateral thecalutein cysts measuring 25 cm. Histopathology confirmed ruptured hydatidiform mole and ruled out active trophoblastic neoplasia. This case demonstrates that the risk of rupture persists after evacuation, requiring continuous monitoring and radical surgery in the event of hemodynamic collapse.