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

INTRODUCTION: Intraperitoneal hemorrhage caused by a uterine myoma is rare (Tajima et al., 2015). PRESENTATION OF CASE: A 47-year-old woman was admitted to the emergency room for worsening abdominal pain. Ultrasound revealed fluid filled almost the entire abdominal cavity as well as the presence of a mass of about 20 cm near the uterus. It was not easy to understand the nature of the fluid by ultrasound. It appeared to be ascites with a tumoral pelvic neoformation. On TC there was extravasation of contrast material, but the bleeding site was not identifiable. An emergency operation was performed. Bleeding was from a subserosalmyoma on the anterior wall of the uterus; myoma measured approximately 20 cm in maximum diameter. Pathological assessment of the resected specimen revealed bleeding from ruptured tortuous veins on a serosal-type uterine myoma. DISCUSSION: 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 (Tajima et al., 2015). CONCLUSION: The differential diagnosis between ascites and hemoperitoneum is sometimes not easy. Ultrasound is a helpful instrument in expert hands to make a diagnosis of hemoperitoneum. The aid of other diagnostic methods as TC help the clinician to arrive at the correct diagnosis quickly.