Acute complications of benign uterine leiomyomas: Treatment of intraperitoneal haemorrhage by embolisation of the uterine arteries

Tumor necrosis after preventive embolization of large renal angiomyolipomas

“…This is consistent with the management of other conditions that require arterial embolization [32,33].…”

Rare gynaecological emergency: massive intraperitoneal haemorrhage from spontaneous rupture of a superficial vessel on a large leiomyoma

“…It has also been postulated that increased intra-abdominal pressure can cause passive venous congestion and subsequent rupture of superficial vessels overlying the fibroid 1 6. Such causes include menstruation, pregnancy, straining during defaecation, strenuous exercise, weight-bearing activity, abdominal massage and violent coitus 6 10. In our patient, no such triggering features were identified, suggesting that the rupture was a rare spontaneous event.…”

“…Intraperitoneal haemorrhage associated with a bleeding vessel from a subserosal leiomyoma is a rare and life-threatening complication of uterine fibroids, with <30 cases being reported between 1950 and 2013 6. Many of these cases report bleeding secondary to trauma or torsion of the fibroid.…”

“…From the initial ultrasound, to investigate her infertility, to the CT scan at the time of presentation with hypovolaemic shock, the fibroid had more than doubled in size. It has also been postulated that increased intra-abdominal pressure can cause passive venous congestion and subsequent rupture of superficial vessels overlying the fibroid 1 6. Such causes include menstruation, pregnancy, straining during defaecation, strenuous exercise, weight-bearing activity, abdominal massage and violent coitus 6 10.…”

“…When the patient is nulliparous, there is additional pressure to conserve the uterus. Fontarensky et al 6 recently reported two cases in which women with hypovolaemic shock, secondary to intraperitoneal haemorrhage from uterine leiomyomas, underwent emergency uterine artery embolisation (UAE) for stabilisation prior to scheduled surgery for definitive management. Where available, such minimally invasive management to stabilise the patient could facilitate a safer myomectomy and thus preserve the uterus in a woman of childbearing age.…”