Spontaneous rupture and massive hemoperitoneum from uterine leiomyomas and adenomyosis in a nongravid and unscarred uterus

Enlarged uterine fibroid forming uterine diverticulum during pregnancy: a case report

“…As a result, the fibroid was dragged out of the uterine muscular axis, which led to the formation of a muscular hernia dragged into part of the endometrial mucosa of the uterus. Like these conditions, the results of ruptured degenerated fibroid or surface vessel cause hematoperitoneum even during pregnancy [15][16][17].…”

Torsion of a uterine leiomyoma – a rare cause of hemoperitoneum; a case report and review of the literature

“…Treatment aims to stop the bleeding and to preserve the uterus, if possible, especially in young women. Myomectomy was reported in 56% of cases (for details see table I); in the rest of the cases, a hysterectomy was performed [11,15,[17][18][19][22][23][24]. In only two cases, uterine artery embolization was the first line of treatment for patient hemodynamic stabilization followed by a hysterectomy [17].…”

Traumatic Avulsion of a Uterine Fibroid after a Motor Vehicle Collision

“…1,2 Although they occur in 20-30 per cent of women aged 30 years and older, fibroids rarely cause acute complications in trauma and, therefore, much of our knowledge comes from case reports. 1,3 Known sequelae of uterine fibroids include thromboembolism, acute torsion of subserosal pedunculated leiomyomata, and acute hemorrhage due to degeneration of the myoma. 4 Factors thought to predispose patients to hemorrhage from fibroids have all been associated with increased intra-abdominal pressure.…”

“…2 Some cases of fibroid avulsion and hemorrhage are able to be treated with myomectomy and repair of the uterus, such as our case, whereas others require a total hysterectomy to control the bleeding. 3,6 There are few case reports of traumatic avulsions of fibroids that result in a free-floating mass in the peritoneum. [7][8][9] It is thought that the mechanism of avulsion involves sheer stress from the uterus and fibroid moving at relatively different rates.…”

“…This theory is further supported by the association of a pelvic fracture with traumatic avulsion of a uterine fibroid reported by Venables et al 8 Although it has been reported that a fibroid larger than 10 cm is a risk factor for spontaneous rupture of superficial vessels leading to hemorrhage, there are not sufficient reports of traumatic avulsion to definitively classify size as a risk factor. 3 In female patients with hemoperitoneum after blunt abdominal trauma, gynecological sources of bleeding must be kept in mind. Furthermore, patients with abdominal pain and an abdominal seatbelt sign should expeditiously be evaluated with a FAST for intraperitoneal hemorrhage.…”