Massive intraperitoneal hemorrhage due to uterine fibroids

Rupture of uterine vessel by twisted leiomyoma causing massive intraperitoneal haemorrhage and hypovolemic shock

“…Posterior location of a bleeding vein supports the theory of direct-contact injury from the promontory of the sacrum. Degeneration of a leiomyoma www.slcog.lk/sljog during pregnancy and puerperium cause spontaneous perforation and bleeding into the abdomen 8,9 .…”

“…The woman's age must be considered in decisions regarding hysterectomy 9 . However, when the condition is critical or when there are multiple uterine leiomyomas and many superficial blood vessels, hysterectomy may be the only appropriate option 14,15 .…”

Hemoperitoneum Due to Rupture of a Subserosal Vein Overlying a Uterine Leiomyoma

“…[1][2][3] The literature indicates that the rupture of subserosal blood vessels overlying uterine leiomyomas usually affects multiparous women aged between 30 and 49 years and occurs in large leiomyomas, ranging in diameter from 10 to 16 cm. [1][2][3][4][5] In the current patient, the size of the leiomyoma was within this range and is consistent with previous data, but the patient was nulliparous and under 30 years old. However, Dahan and Ahmadi 4 report that a patient's age and parity, and the size of the leiomyoma may not be the only risk factors.…”

“…Fewer than 100 cases of hemoperitoneum due to rupture of a subserosal vein overlying a uterine leiomyoma have been reported worldwide since 1861. [1][2][3] According to Deopuria's review, there were 7 deaths reported out of 27 cases that recorded a rupture of a subserosal vein overlying uterine leiomyoma before 1928, and only 1 death in 36 cases was recorded from 1929 to 1970. 2 Furthermore, there may not have been any fatal cases from 1970 to 2005, since no new articles were found within the English language literature.…”

“…Increased blood flow around the uterus, as during menstruation or pregnancy, and increased abdominal pressure can trigger a venous rupture, but the pathophysiology of venous rupture is not fully understood. [1][2][3][4][5] A rupture of a vein overlying a uterine leiomyoma can lead to a massive hemoperitoneum and hypovolemic shock. 1 CASE A 28-year-old Japanese woman was taken to the hospital while in cardiopulmonary arrest.…”