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

Abstract

Uterine leiomyomas rarely present as gynaecological emergencies. We report a case of a 29-year-old nulliparous woman, with a negative pregnancy test, who presented with collapse and an admission haemoglobin count of 68 g/L. Urgent CT of the abdomen revealed a 14 × 19 × 10 cm uterine fibroid and intraperitoneal free fluid. Emergency laparotomy confirmed massive intraperitoneal haemorrhage from a large serosal vessel on top of a 19 cm subserosal fibroid. A myomectomy was performed, preserving this patient's fertility. Histopathology confirmed a benign leiomyoma with hydropic changes.

Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature

“…Additionally, vessel rupture can be either spontaneous or traumatic. Similar to the current case, reports of spontaneous venous rupture causing hemoperitoneum and hypovolemic shock have been reported [9,13,14]. Schwartz and Powell reported a case of a 53-year-old woman with a known history of uterine leiomyoma with unrelenting acute abdominal pain and a positive FAST exam.…”

“…Spontaneous avulsion of a leiomyoma with active hemorrhaging from the right uterine artery was the perpetrator behind the bleeding [13]. Additionally, Gulati et al performed a fertility-sparing myomectomy in a 29-year-old with hemoperitoneum resulting from spontaneous rupture of a serosal vessel overlying a subserosal leiomyoma [14]. In contrast to spontaneous rupture, cases with specific etiologic agents have also been reported [4].…”

A Case of Hemoperitoneum Due to Spontaneous Bleeding from a Uterine Leiomyoma

“…Akahira et al [24] reported the case of a 44-year-old multiparous woman with hemoperitoneum due to a ruptured artery overlying a uterine leiomyoma, who underwent total abdominal hysterectomy. Gulati et al [25] reported a case of a 29-year-old nulliparous woman with intraperitoneal hemorrhage from a large serosal vessel, who underwent myomectomy in an attempt to preserve the fertility of the patient. Cerruto et al [26] reported a case a 47-year-old woman, with three previous pregnancies, who underwent hysterectomy with ovarian conservation.…”

Acute abdomen caused by internodular bleeding from a multiple myoma pseudocapsule in a postmenopausal woman

“…Uterine myomas are benign female tumours with an estimated prevalence of 25% 1. Symptoms depend on the location and size of the myomas; some myomas are asymptomatic 2 3. In our case, the uterine myoma was relatively large (14 cm in size), but the patient was asymptomatic.…”