Uterine leiomyoma with spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum in postmenopausal woman: Computed tomography diagnosis

Alharbi, Sultan

doi:10.4103/2231-0770.118465

Cited by 3 publications

(4 citation statements)

References 8 publications

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“…However, Salehi et al [31] reported a case of a 15-year-old adolescent with a 9.5/8.4/10.7 cm heterogeneous, hypoattenuating, symptomatic solid adnexal mass that resulted in being a degenerative uterine leiomyoma. Several other cases in the puerperal period, in perimenopause or even in postmenopause have been reported [18,26].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

2019

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Uterine leiomyomas are common benign uterine tumors but by contrast, their acute complications are very rare. We present an unusual case of 38-year-old woman that came to the emergency department with acute abdominal pain. The ultrasound revealed hemoperitoneum, a uterus with two intramural fibroids and a tender inhomogeneous pelvic mass that seems to connect with the uterus. Computer tomographic (CT) examination raised the suspicion of a degenerated fibroid and hemoperitoneum. Emergency laparotomy was performed: the hemoperitoneum was determined by a degenerated fundal subserosalfibroid. Myomectomy was subsequently carried out. Even though this condition is extremely rare, every clinician has to bear in mind that acute fibroid complications can be a potential cause of acute abdominal pain that requires immediate surgery. The imagistic tools, ultrasound and CT are extremely helpful for the diagnosis.Due to its relative rarity in the second part of the article we have performed a review of the existing literature regarding the acute complications of fibroid torsion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

2019

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“…While haemoperitoneum in association with rupture of a vessel overlying the fibroid is well-described in the literature, to our knowledge only seven other cases of rupture of a degenerated fibroid have been described in the literature [1][2][3][4][5][6][7]. All cases presented with abdominal pain, distension or symptoms of cardiovascular compromise.…”

Section: Michaela Weingarten [ 1 1 _ T D $ D I F F ] [ 1 0 _ T D $ D mentioning

confidence: 99%

“…The preoperative diagnosis was usually acute abdomen of uncertain cause, or acute adnexal pathology. In five of these eight cases [2,[4][5][6], a hysterectomy was performed at the time of the diagnostic operation. All patients recovered after their surgery.…”

Section: Michaela Weingarten [ 1 1 _ T D $ D I F F ] [ 1 0 _ T D $ D mentioning

confidence: 99%

Degenerated uterine fibroid with rupture of the surface leading to haemoperitoneum

Mistry

Bhatt

Haque

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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bleeding was not controlled despite the use of Misoprostol, Syntocinon infusion, Ergometrine, four doses of carboprost, tranexamic acid, 4 units of fresh frozen plasma and recombinant Factor VII. In view of the life-threatening situation, the benefits of the autologous transfusion was considered to outweigh the potential risk of infection and the small risk of amniotic fluid embolism, and a joint decision was made by 2 obstetricians to re-infuse the vaginally salvaged blood. Prior to the manual removal of the placenta, the perineum and vagina had been cleaned with aseptic precautions and covered with sterile drapes. The vaginal blood was retrieved directly via a wide bore suction cannula. Large blood clots retrieved vaginally were collected in a sterile dish under aseptic precautions, from which it was recycled and processed by the cell salvage machine (Haemonetics). She was transfused 380 ml of recycled blood processed with leucocyte-depletion filter. Intraoperatively, she had received further doses of cefuroxime and metronidazole. Haemostasis was achieved after four doses of carboprost tromethamine, two units of cryoprecipitate and two doses of factor VII. The haemoglobin was 7.4 g/dl, platelets and coagulation were normal. Postoperatively, she was monitored on the high dependency unit for 48 h. Intravenous cefuroxime and metronidazole was continued for 48 h followed by oral therapy for seven days. One hour after the bleeding was controlled, she had a temperature of 38.2 C which settled after intravenous paracetamol. She had no further febrile episodes and blood cultures at 48 h was negative. She had no objective signs of postnatal sepsis and recovered well thereafter. She was debriefed about steps undertaken for autologous blood transfusion and the risk of alloimmunization, which was small and not definitely quantifiable. This rare case provides an observation that it is possible to safely retrieve blood lost per vaginum, recycle and re-infuse the blood, without the patient developing complications.This is especially relevant in the context of lessons learnt from previous confidential enquiries addressing steps undertaken in major haemorrhage [4,5]. Therefore, future research should focus on the safety, feasibility and wider application of this therapeutic intervention in cases of major postpartum haemorrhage, especially in those patients who decline allogeneic blood.

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Hypovolaemic shock due to intra-abdominal haemorrhage from multiple uterine fibroids

et al. 2021

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Intra-abdominal bleeding due to uterine fibroids is extremely rare, and preoperative diagnosis is difficult. Herein, we report a case of preoperatively diagnosed hypovolaemic shock due to intra-abdominal haemorrhage, in which fatal sequelae were prevented. A 46-year-old non-pregnant woman was brought to the hospital with a sudden-onset lower abdominal pain. On admission, she was in shock, and abdominal CT showed severe intra-abdominal haemorrhage. Since bleeding from uterine fibroids was suspected, an emergency simple total hysterectomy was performed, and her condition became stable after the operation. Intra-abdominal haemorrhage with hypovolaemic shock requires prompt surgical intervention. Although it occurs very rarely due to bleeding from uterine fibroids, imaging shows large fibroids; if the patient is not pregnant, bleeding from the fibroids should be considered.

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Uterine leiomyoma with spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum in postmenopausal woman: Computed tomography diagnosis

Cited by 3 publications

References 8 publications

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

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

Degenerated uterine fibroid with rupture of the surface leading to haemoperitoneum

Hypovolaemic shock due to intra-abdominal haemorrhage from multiple uterine fibroids

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