Hemoperitoneum followed by Red Degeneration of Uterine Myoma

Min, Kyung Jin; Song, Ki Jung; Baek, Yoo Jin; Yeo, Min Koo; Lee, Jae Kwan; Oh, Min Jeong; Saw, Ho Suk; Hur, Jun Young; Park, Yong Gyun

Abstract

Spontaneous intra-abdominal hemorrhage from uterine leiomyomas is rarely encountered. We present a case of a 46-year-old who presented to the emergency room with acute abdominal pain as same as that has experienced for 5-6 times. On examination, the abdomen was diffusely tender, with rebound tenderness in the suprapubic area and in both iliac fossae. Pregnancy test was negative. She had an acute abdomen, dizziness, decreasing hematocrit, and a pelvic mass with free fluid in the pelvic cavity. On transvaginal sonography, 6.3 x 6.1 cm sized hyperechoic mass was visible beside the uterus and CDS. This mass had an ill-defined margin. Large amount of fluid was visible in the CDS and uterovesical pouch. Hemoperitoneum was confirmed by culdocentesis. Magnetic Resonance Imaging revealed a mass with cystic components, diffusely heterogeneous signal intensity and T1 high signal intensity in the left superolateral aspect of uterus. An moderate amount of fluid was found in the pelvic cavity. The patient underwent an exploratory laparotomy. A ruptured, pedunculated, cystic degenerated uterine myoma with active bleeding was found, as well as approximately a liter of free, blood-stained peritoneal fluid and blood-clots. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.