Hemoperitoneum secondary to rupture of a superficial uterine artery overlying a subserous myoma with no predisposing factors in a young woman

Abstract

Uterine leiomyomas (fibroids, myomas) are common pelvic tumors in women of reproductive age [1], whereas spontaneous intraperitoneal hemorrhage due to uterine leiomyoma is extremely rare [2]. The origin of spontaneous intraperitoneal hemorrhage of uterine myomas is often derived from veins, and may cause anemia and hypovolemic shock afterward [3]. From the perspective of gynecology, hemoperitoneum is usually caused by ectopic pregnancy, ruptured corpus luteum, or adnexal torsion [4e6], and the bleeding is usually venous in origin and can be severe or even life threatening. The diagnosis is often delayed to the time of operation. Recently, we encountered a case of spontaneous hemorrhage of hemoperitoneum resulting from a uterine leiomyoma in a young woman. This hemorrhage was secondary to a spontaneous rupture of a superficial uterine artery overlying a subserous myoma without any predisposing factors. A 22-year-old woman, gravida 0, with no gynecologic or medical condition, surgery, or prior sexual experience, was sent to the emergency department with a sudden onset of acute abdominal pain that was accompanied by bilateral shoulder pain. The patient’s last menstruation occurred 7 days before she presented to the emergency department. No trauma or other associated gastrointestinal or genitourinary system problems were noted. Urine pregnancy test was negative. Examination revealed an afebrile woman in moderate distress (blood pressure: 90/ 60 mmHg; pulse rate: 96 beats/min). Hemoglobin measured 10.6 g/dL. Transabdominal ultrasound showed excessive free fluid at the Morrison pouch and the Douglas pouch, as well as