Large hemorrhagic ovarian cyst in postmenopausal patient with autosomal dominant polycystic kidney disease

387 are malignant.[2] The large ovarian cyst can undergo torsion at any time leading to acute abdominal pain and necrosis of the ovary. Patients are also at risk of developing sepsis due to torsion. Massive ovarian cyst hemorrhage can occur in anticoagulated patients, including those on hemodialysis, who receive heparin anticoagulation.[3] Such cyst may rupture accidentally during continuous ambulatory peritoneal dialysis leading to intraperitoneal hemorrhage, which can be confused with bleeding caused by placement of percutaneous intra-abdominal catheter as a result of direct vascular or visceral damage.[4] Hence, patients who are on chronic intermittent hemodialysis should have regular gynecology check up to rule out any ovarian cyst and should be managed accordingly.