Haemoperitoneum: an extremely rare complication of leiomyoma

A rare complication of uterine leiomyomata: Severe haemoperitoneum caused by the rupture of an overlying subserosa variceal vein: A case report

The rupture of a subserosa variceal vein overlying a uterine myoma is a rare complication and a less common cause of gynecologic haemoperitoneum. The literature data are scarce regarding this condition and less than 100 cases have been reported (including those occurring during pregnancy). The present case is of a 48-year-old woman, with a history of asymptomatic uterine myoma, who was hospitalised for severe abdominal pain with sudden onset and signs of hypovolemic shock. The emergency conventional imaging exams confirmed the diagnosis of uterine myoma and haemoperitoneum, but did not reveal the source of bleeding. The cause of haemoperitoneum was detected by means of emergency laparotomy. In order to obtain quick hemostasis, in the settings of a rapid deteriorating hypovolemic shock, a supracervical hysterectomy was performed. The aim of the article is to raise awareness to gynecologists regarding this extremely rare life-threatening complication of the most common benign tumor of the uterus.

Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature

INTRODUCTION

While uterine leiomyomas are the most common pelvic tumors in females, resultant hemoperitoneum is an extremely rare and acute complication which requires emergent intervention and resuscitation. To date, less than one-hundred cases have been reported in the literature.

PRESENTATION OF CASE

We report a case of massive hemoperitoneum due to spontaneous rupture of a 20 cm pedunculated leiomyoma in a 74-year-old female who presented as a trauma alert. Rapidly declining hemodynamic status with an ultrasound consistent with extensive hemoperitoneum led to activation of the massive transfusion protocol and an emergent laparotomy. In the operating theater the laparotomy revealed 4 L of blood. She underwent a myomectomy and subsequently, an angiogram and embolization of a bleeding uterine artery. In all, she required transfusion of 26 units of blood. Post operatively she was discharged home on hospital day 13.

DISCUSSION

Near fatal hemoperitoneum secondary to a uterine leiomyoma may be due to traumatic or spontaneous rupture of an overlying vein or artery. Leiomyomas greater than 10 cm in size have an increased risk of rupturing. A significant amount of blood can accumulate in the peritoneum resulting in hypovolemic shock.

CONCLUSION

Acute complications of uterine leiomyomas requiring surgical intervention are exceptionally rare. Candidates for the massive transfusion protocol must be appropriately and timely identified. Additionally, because surgery is a potential treatment for hemorrhage control in leiomyoma-related hemoperitoneum, surgeons should be aware of such complications.