Massive hemoperitoneum due to rupture of surface veins of a uterine leiomyoma

Vidyadhar B Bangal,Kanika Gupta,Satyajit P Gavhane,Nitin Ghorpade,Gangapurwala Sonika,Kunaal K Shinde

doi:10.7439/ijbar.v5i2.666

Abstract

Rupture of veins on the surface of uterine leiomyoma is an extremely uncommon gynaecological cause of hemoperitoneum .It is a life threatening emergency. We report a case of massive intraperitoneal hemorrhage due to rupture of vessels on the surface of subserous leiomyoma.The patient underwent diagnostic laparoscopy followed by laparotomy and hysterectomy. She received 5 units of fresh blood transfusion and had smooth postoperative period. A differential diagnosis of rupture of surface vessel of leiomyoma should be considered, while dealing with a case of hemoperitoneum with pelvic mass.

Highlights

Uterine leiomyoma is a frequently seen benign tumour in women of reproductive age group
Bleeding from the surface of uterine leiomyoma is a rare cause of hemoperitoneum.[1]
Diagnostic laparoscopy revealed gross collection of blood clots occupying whole of pelvic cavity and covering the uterus and adnexa. (Fig.1) There was a round tumour seen on the top of the collected blood clots, whose surface showed actively bleeding vessel

Summary

Introduction

Uterine leiomyoma is a frequently seen benign tumour in women of reproductive age group. Bleeding from the surface of uterine leiomyoma is a rare cause of hemoperitoneum.[1] In most cases, bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein of fibroid is extremely rare.[2] It is a life threatening emergency. Fewer than 100 cases have been reported.[3]

Case Report

Discussion