Abstract
A 47-year-old nulliparous, virginal woman presented to the emergency department with acute abdominal pain. Emergency pelvic ultrasound and abdominal CT were taken, which showed a significant amount of hemoperitoneum and a bicornuate uterus with about 18cm x 10cm mass on left uterus. Since the mass had increased vascularity and irregular margins, we thought that the mass could be a uterine sarcoma. MRI and PET/CT were taken additionally for oncologic evaluation before surgery. Intra operative findings showed a ruptured bicornuate uterus with a large mass within the left uterine horn. Total abdominalhysterectomy with bilateral salpingo-oophorectomy was performed. Pathologic analysis confirmed an undifferentiated uterine sarcoma. She was treated with 6 cycles of chemotherapy(etoposide, ifosfamide, cisplatin) postoperatively. Chest and abdomen CT for follow up after chemotherapy showed no sign of cancer recurrence. We suggest a bicornuate uterus with concomitant sarcoma should be concerned as a possible cause of uterine rupture by reviewing this case.
Highlights
We suggest that a bicornuate uterus with concomitant sarcoma should be concerned as a possible cause of uterine rupture when a woman presents with hemoperitoneum in the setting of a pelvic mass and uterine anomaly with intact ovaries detected on imaging
Almost the entire posterior wall of the uterus is covered by serosa, that is, visceral peritoneum
Uterine rupture can present with both complete rupture involves the full thickness of the uterine wall and incomplete rupture occurs with the visceral peritoneum remains intact
Summary
Pelvic MRI was performed on the day after the patient’s initial presentation, revealed underlying uterus didelphys with an approximately 15- × 9- × 17-cm mass with mixed signal intensity in the lower abdominal area (Figure 2) and an approximately 6- × 2.7- × 3-cm mass of the left cervix and lower uterine body on T2-weighted imaging. These MRI findings suggested the possibility of hemoperitoneum or cancer peritonei due to rupture of (1) endometrial cancer, (2) uterine sarcoma, or (3) large myoma with degeneration. There were no sign of cancer recurrence in the chest and abdominal CT
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