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

Abstract

A 26 year old nullipara who was diagnosed with multiple uterine leiomyomata, presented in the emergency care unit with acute lower abdominal pain and slight vaginal bleeding. On admission to hospital, three hours after the onset of pain, she was very pale her skin was cold and was feeling faint, the temperature was 37.5°C pulse 92 beats per minute, blood-pressure 95/60 mmHg and respiration was 36 per minute. The chest and heart were normal. The abdomen was distended with generalized tenderness and rigidity, most pronounced over the suprapubic region. Pregnancy test was negative. Ultrasound scan revealed multiple uterine leiomyomata and free fluid in the peritoneal cavity. The diagnosis of acute abdomen due to haemoperitoneum was made.