Spontaneous rupture and massive hemoperitoneum from uterine leiomyomas and adenomyosis in a nongravid and unscarred uterus

Abstract

Uterine leiomyomas (fibroids or myomas) are benign monoclonal tumors arising from the smooth muscle cells of the myometrium [1]. The symptoms attributed to myomas include heavy or prolonged menstrual bleeding, pelvic pressure and pain, and reproductive dysfunction. Acute or chronic pelvic pain may be a result of mass bulk-related symptoms, dysmenorrhea, dyspareunia, or degeneration or torsion of the myoma [2]. Adenomyosis refers to a disorder in which endometrial glands and stroma are present within the uterine musculature (uterine adenomyomatosis). Heavy menstrual bleeding, painful menstruation, and chronic pelvic pain are the major symptoms of adenomyosis, and they occur in approximately 25% of cases [3]. Although leiomyomas and adenomyosis are common gynecological disorders, hemorrhage, internal bleeding, hemoperitoneum, and uterine rupture due to these disease etiologies are rare and can easily be missed in emergency conditions. Furthermore, delayed diagnosis and management may increase the risk of morbidity andmortality [4,5]. Herein, we report an extremely rare case presenting as spontaneous rupture from uterine leiomyomas with adenomyosis in a nongravid and unscarred uterus. A 39-year-old female presented to our emergency department in shock and near fainting condition accompanied with acute diffuse lower abdomen pain. Her medical history was unremarkable, and she denied undergoing any surgery such as laparoscopy or laparotomy for uterine tumors. She denied being pregnant, having given birth, or undergoing an abortion in the past and denied having an