Spontaneous uterine rupture in a nulligravida female presenting with unexplained recurrent hematometra

Spontaneous rupture of an unscarred uterus in reproductive-age women is exceedingly rare, especially in the context of dysfunctional bleeding and a patent cervical canal. A 25-year-old nulligravida female, who reported recent onset of metromenorrhagia and anemia, was initially admitted for surgical management of unexplained hematometra requiring dilation and curettage. The patient remained with intermittent vaginal bleeding for the following six months on continuous progestin therapy. She then re-presented with enlarged hematometra and uterine rupture, which was surgically repaired. Despite exhaustive conservative treatment to preserve fertility, hysterectomy was eventually required due to recurrent uterine rupture. Idiopathic recurrent hematometra can result from the rare combination of uncontrolled dysfunctional bleeding and absence of outflow obstruction.