Abstract
Spontaneous venous rupture overlying a uterine fibroid is a rare cause of hemoperitoneum. A 38-year-old woman presented to the emergency department with acute onset of abdominal pain. The ultrasound revealed multiple fibroids and free fluid in the peritoneum. There was a significant drop of the hemoglobin and hematocrit. The patient underwent emergent exploratory laparoscopy. A subserosal uterine leiomyoma was found, with a bleeding vein on its basis and massive hemoperitoneum. Laparoscopic myomectomy was successfully performed with local injection of vasopressin and intraoperative autologous blood transfusion. This case suggests that spontaneous intraperitoneal haemorrhage associated with uterine fibroids, although rare, should be considered in women with hypovolemic shock and a pelvic mass.
Highlights
Spontaneous venous rupture overlying a uterine fibroid is a rare cause of hemoperitoneum
Spontaneous venous rupture overlying a uterine fibroid is an unusual cause of hemoperitoneum, which may be catastrophic if it is not promptly diagnosed and treated [1,2,3]
We report the unusual case of hemoperitoneum caused by venous rupture of a uterine fibroid, which was successfully treated by laparoscopy
Summary
Spontaneous venous rupture overlying a uterine fibroid is an unusual cause of hemoperitoneum, which may be catastrophic if it is not promptly diagnosed and treated [1,2,3]. Because of the location of the pain, an upper abdominal ultrasound was performed and showed moderate amount of free fluid in Morrison’s pouch, and multiple uterine fibroids. Magnetic resonance (MR) imaging revealed multiple fibroids (mainly two fibroids of 6 cm in diameter) occupying the pelvic cavity and hemorrhagic ascites, which was prominent around the basis of the well-circumscribed pedunculated fundal fibroid (Figure 1). Because marked hemoperitoneum was noted and no symptoms due to uterine fibroid existed, laparoscopic myomectomy for the bleeding fibroid was performed. 2800 ml of blood were suctioned from the abdominal cavity and the processed blood was reinfused for autologous transfusion during surgery with Cell Saver 5
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