Hemoperitoneum due to breaking uterine adenosarcoma located in the omentum. Report of a case

We report an unusual case of broken adenosarcoma located in the omentum that has procured a clinical situation of acute abdomen in a patient.

A 79 year-old woman went to the emergency room for growing abdominal pain and then transferred to our department. In previous years the patient had removed endo-cervical and endometrial fibro-glandular polyps and subsequently to a total laparoscopic hysterectomy with bilateral oophorectomy was performed for another endometrial fibroglandular polyp; other vaginal recurrences were then removed. We performed a computed tomography thanks to which we made a diagnosis of moderate hemoperitoneum.

The patient underwent to a laparotomy. After abdominal blood removal was evidenced the presence of a damaged big cystic formation starting from the epiploon, containing blood and necrotic debris treated with omentectomy. The subsequent histopathological examination revealed that this tumor was an adenosarcoma.

Rarely adenosarcoma can grow in extrauterine locations. The simptoms are related to the localization. Even during an emergency surgery it is important to respect the criteria of oncological radicality. You must avoid the tumor dissemination in order to reduce late recurrences, and to achieve a better final histologic diagnosis should avoid intraoperative extemporaneous histological examination.

This case is an example of how many diagnostic pitfalls you can hide in emergency surgery, but in conclusion it remains a doubt about our experience: it is not possible to know if this tumor was a primary extra-uterine neoplasm or a recurrence of fibro-glandular polyps removed years before already in malignant transformation?

Acute Abdomen, Adenosarcoma, Hemoperitoneum, Omentum.