Torsion of a uterine leiomyoma – a rare cause of hemoperitoneum; a case report and review of the literature

Abstract

Uterine leiomyomas are common benign uterine tumors but by contrast, their acute complications are very rare. We present an unusual case of 38-year-old woman that came to the emergency department with acute abdominal pain. The ultrasound revealed hemoperitoneum, a uterus with two intramural fibroids and a tender inhomogeneous pelvic mass that seems to connect with the uterus. Computer tomographic (CT) examination raised the suspicion of a degenerated fibroid and hemoperitoneum. Emergency laparotomy was performed: the hemoperitoneum was determined by a degenerated fundal subserosalfibroid. Myomectomy was subsequently carried out. Even though this condition is extremely rare, every clinician has to bear in mind that acute fibroid complications can be a potential cause of acute abdominal pain that requires immediate surgery. The imagistic tools, ultrasound and CT are extremely helpful for the diagnosis.Due to its relative rarity in the second part of the article we have performed a review of the existing literature regarding the acute complications of fibroid torsion.

Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature

“…Additionally, we report the largest leiomyoma—20 × 20 × 15 cm—to cause hemoperitoneum and hemorrhagic shock as a result of spontaneous bleeding of a pedunculated leiomyoma. Previously in the literature, leiomyomas complicated with hemoperitoneum varied in size from 4 cm to 16.3 cm [4]. Furthermore, to our knowledge, this is the first case of uterine leiomyoma complicated with hemoperitoneum that presented as a trauma alert.…”

“…Common complications include pelvic pain arising due to degeneration, menorrhagia, and metrorrhagia [7]. Rarely, acute complications may arise and include urinary retention, renal failure, thromboembolism, and intraperitoneal hemorrhage due to torsion or avulsion of a pedunculated leiomyoma [4,8,9]. Fatal hemorrhage is an exceptionally rare complication [1].…”

“…Additionally, Gulati et al performed a fertility-sparing myomectomy in a 29-year-old with hemoperitoneum resulting from spontaneous rupture of a serosal vessel overlying a subserosal leiomyoma [14]. In contrast to spontaneous rupture, cases with specific etiologic agents have also been reported [4]. Estrade-Huchon et al reported life-threatening hemoperitoneum in a 46-year-old female after she had sustained a fall.…”

“…Hemoperitoneum secondary to rupture of a uterine leiomyoma is an extremely rare complication of this exceedingly common tumor. To date, there have been approximately 100 cases of hemoperitoneum resulting from leiomyomas reported in the literature [4,5]. Less than 30 of these cases resulted from rupture of a superficial vessel [2].…”

Successful Embolization of Collaterals from the Round Ligament Artery during Uterine Artery Embolization for Traumatic Uterine Leiomyoma Rupture: A Case Report

“…Hemoperitoneum due to rupture of a uterine leiomyoma is rare, with less than 100 cases reported in the literature [6]. Based on previous reports, most cases correspond to spontaneous avulsion of the uterine leiomyoma in the absence of any trauma.…”