Unusual Presentation of Hemoperitoneum Due to Spontaneous Rupture of Surface Vein Overlying Leiomyoma: A Case Report

Fibroids are the most common pelvic tumors in women; serious complications are very rare but can be life threatening also. This case report highlights the atypical presentation of spontaneous hemorrhage and gangrene from a uterine myoma that clinicians should consider as a differentials diagnosis of haemoperitonium. It adds to the existing literature in discussing the investigations and management of these rare fibroid complications. We present a case of an atypical presentation of spontaneous hemorrhage from a uterine fibroid with gangrene with no precipitating factors. A 36-year-old lady who was diagnosed as a case of sub serous pedunculated fibroids presented to us with acute abdominal pain and high fever in an unstable condition who required 2 units of blood transfusion. Her ultrasound examination revealed abdominopelvic ascites, two solid pelvic mass most likely right adnexal origin, her vital signs revealed tachycardia with raised temperature, her abdomen was soft but tender with mild distension. Her tumor marker was raised CA-125 (137μ/ml), there was neutrophilic leucocytosis, negative urine pregnancy test-all together made a diagnostic dilemma, so plan for exploratory laparotomy was done with frozen section biopsy facility. After laparotomy a huge hemoperitonium was found. Hemorrhagic fluid was sent for cytology. Two large twisted gangrenous fiboids were found, there was bleeding from surface vein overlying uterine myoma. Gangrenous myoma was sent for frozen section biopsy. After frozen section biopsy report definitive surgery was done with preservation of one ovary. Patient was discharged on 4th post-operative day with no complaints. Haemorrhage and gangrene secondary to a uterine fibroid are a rare complication of uterine fibroids that clinicians must consider. Initial rapid imaging can be used to narrow down the diagnosis. Prompt resuscitation, definitive surgical management in a multidisciplinary team approach will aid in management and improve outcomes.