Ovarian Complications in Von Willebrand Disease

Diagnostic Considerations

• Difficulty urinating suggests possible mass effect or peritoneal irritation from rupture or torsion, which is a critical consideration in patients with Von Willebrand disease 1
• A contrast-enhanced CT scan of the abdomen and pelvis with IV contrast is recommended to evaluate for torsion, rupture, or active bleeding, as it is superior to ultrasound for detecting free fluid/hemoperitoneum and ovarian torsion 2, 3

Imaging Recommendations

• CT scan is superior to ultrasound for detecting free fluid/hemoperitoneum from cyst rupture, ovarian torsion, and active arterial bleeding 2, 3
• Doppler flow assessment of the ovary is critical, as absent or decreased flow suggests torsion, and E-FAST can rapidly detect free fluid in the peritoneal cavity with 97% positive predictive value for intra-abdominal bleeding 2

Facility and Specialist Considerations

• Patients with suspected ovarian complications and Von Willebrand disease should be evaluated at a tertiary care center with 24/7 gynecologic surgery availability, hematology consultation, and interventional radiology capabilities 3