Diffuse Intraperitoneal Haemorrhage from Surface Vein of a Fibromyoma

Abstract

BR 717The fifth and sixth weeks were a period of rapid improvement. She was no longer incontinent at night; she could walk without support, knit simple patterns, carry on a conversation, and read women's periodicals, but was still unable to perform tasks which required concentration, such as the simplest mental arithmetic.At the time of her discharge fromn hospital, nine weeks after operation, she could walk well but still had a slurred speech and some ataxy of both arms. An electrocardiogram showed anterior ischaemia of the left ventricle. DiscussionThe discussion in this case can be conveniently divided into three sections.Ruptured Uterus.-This was a case of gradual and complete rupture of the uterus in a fit young woman near term, who had had one previous uncomplicated confinement, one curettage, and one spontaneous abortion. This was a most unusual occurrence, and naturally a predisposing factor was sought. The only positive factors which emerged from a careful study of the case notes were: (1) an apparently uncomplicated curettage in 1956, (2) a spontaneous abortion in 1957, and (3) attempted external cephalic version at the thirtysecond week of this pregnancy. None of the usual causes of ruptured uterus such as dystocia, previous caesarean section or myomectomy, developmental uterine abnormality, intrauterine manipulation, or grand multiparity could be incriminated. It was felt that the three positive factors mentioned were unlikely to have been of aetiological significance, and one is left with the feeling that this was a spontaneous rupture through the lower uterine segment.Cardiac Arrest.-The probable reason for the cardiac arrest was a combination of haemorrhage, reflex hypotension, impedance of the venous return to the heart by the head-down tilt, and manually controlled respiration. Under these conditions the smallest supplementary dose of thiopentone would be likely to deliver the coup de grdce to an already tottering circulation. The clinical picture which followed operation-namely, tonic fits superimposed on a decerebrate posture with initial pyrexia, not completely thermolabile-bore a striking resemblance to those cerebral injuries with brain-stem damage and a good prognosis (Maciver et al., 1958

Difficult diagnosis of hemoperitoneum in a patient with a pelvic mass of large size

“…In a gynecological setting, hemoperitoneum is usually a result of an ectopic pregnancy, a ruptured corpus luteum, or adnexal torsion [3] , [4] , [5] . As a cause of hemoperitoneum, spontaneous rupture of a vein or an artery overlying a myoma has been documented in English literature on the subject, although it is extremely rare [6] , [7] , [8] , [9] , [10] , [11] , 12] , [13] , [14] , [15] , [16] . Even if cases reported in non-English language publications are included, there have been fewer than 100 documented cases to date [11] .…”