Hemoperitoneum from Spontaneous Bleeding of a Uterine Leiomyoma: A Case Report

• Published in: The American surgeon Vol. 65; no. 12; pp. 1180 - 1182
• Main Authors: Danikas, Dimitrios, Theodorou, Spero J.V., Kotrotsios, John, Sills, Charles, Cordero, Pedro E.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.12.1999; Southeastern Surgical Congress; SAGE PUBLICATIONS, INC
• Subjects: Adult; Biological and medical sciences; Case studies; Diagnosis, Differential; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Hematocrit; Hemoglobins - analysis; Hemoperitoneum - etiology; Humans; Laparotomy; Leiomyoma - blood supply; Leiomyoma - complications; Medical diagnosis; Medical sciences; Premenopause; Reproductive system; Rupture, Spontaneous; Tumors; Uterine Neoplasms - blood supply; Uterine Neoplasms - complications; Veins; Leiomyoma; Hemoperitoneum; Spontaneous; Cardiovascular disease; Hemorrhage; Vascular disease; Uterus; Surgery; Uterine diseases; Adult; Complication; Female; Benign neoplasm; Diagnosis; Sonography; Human; Effusion; Female genital diseases; Case study; Treatment; Abdominal disease; Echography; Emergency; Laparotomy; Peritoneum
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313489906501219

Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine “fibroid.” In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.