Massive hemoperitoneum in case of large subserosal fibroid- a rare case report

Abstract

Rupture of veins on the surface of uterine leiomyoma is an extremely uncommon gynaecological cause of haemoperitoneum. It is a life-threating emergency. In most cases, bleeding is a result of trauma or torsion. Here we report a case of massive intraperitoneal haemorrhage due to rupture of vessels on the surface of large sub-serous leiomyoma to stress on the fact that a differential diagnosis of rupture of surface vessels in a fibroid should be considered while dealing with a case of haemoperitoneum with pelvic masses

Emergency laparoscopic myomectomy in a rare case of hemoperitoneum from uterine leiomyoma

“…[14][15][16] Most of the cases reported in literature were managed by laparotomy and here we present the laparoscopic management of emergency myomectomy. 7,14,17 In our case, a pre-operative differential diagnosis was sorted andadequate facility for fluid replacementensured and once in-detail counselling for laparoscopy was done, emergency laparoscopy with emergency laparoscopic myomectomy and evacuation of organised blood clots done. As she was laparoscopically managed without delay, patient recovery was rapid and satisfactory.…”

“…5,6 The causes of hemoperitoneum or acute abdomen related to leiomyoma include rupture of leiomyoma, rupture of subserosal vein or bleeding from subserosal artery or a lacerated leiomyoma or avulsed pedunculated leiomyoma or torsion of pedunculated leiomyoma. [7][8][9][10] Spontaneous surface bleeding from the subserosal asymptomatic myoma is extremely rare but should be considered as a differential diagnosis in a reproductive age woman with a negative pregnancy test. 11,12 This spontaneous bleeding from subserosal fibroids have been reported and most commonly originating from vein as in our case.…”