A Case of Hemoperitoneum Due to Spontaneous Bleeding from a Uterine Leiomyoma

Patient: Female, 26 Final Diagnosis: Uterine leiomyoma Symptoms: Abdomen distension • acute abdomen Medication: — Clinical Procedure: Exploratory laparotomy Specialty: Obstetrics and Gynecology OBJECTIVE: Unusual clinical course BACKGROUND: Uterine leiomyoma, or uterine fibroid, is the most common gynecologic neoplasm and its management usually results in a good clinical outcome. This report is of a rare case of hemoperitoneum associated with spontaneous hemorrhage from a benign uterine leiomyoma. CASE REPORT: A 27-year-old single woman presented with generalized acute abdominal pain and vomiting. Clinical examination showed a distended abdomen and unstable vital signs. Following active resuscitation, ultrasound and computed tomography (CT) imaging showed an intraperitoneal fluid collection and heterogenous uterine mass. The patient underwent emergency laparotomy with the identification of bleeding blood vessels, which were clipped, resulting in hemostasis. The uterine lesion was completely excised and histopathology confirmed the diagnosis of benign leiomyoma. The patient’s postoperative course was unremarkable. Five days following admission, the patient was discharged from hospital without further complications. CONCLUSIONS: Hemoperitoneum secondary to spontaneous hemorrhage from a benign uterine leiomyoma is rare. This case demonstrates that clinical history, imaging, and surgical exploration are required to identify and control the source of bleeding to prevent a potentially fatal outcome.