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Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature.
Int J Surg Case Rep. 2019; 61:51-55.IJ

Abstract

INTRODUCTION

While uterine leiomyomas are the most common pelvic tumors in females, resultant hemoperitoneum is an extremely rare and acute complication which requires emergent intervention and resuscitation. To date, less than one-hundred cases have been reported in the literature.

PRESENTATION OF CASE

We report a case of massive hemoperitoneum due to spontaneous rupture of a 20 cm pedunculated leiomyoma in a 74-year-old female who presented as a trauma alert. Rapidly declining hemodynamic status with an ultrasound consistent with extensive hemoperitoneum led to activation of the massive transfusion protocol and an emergent laparotomy. In the operating theater the laparotomy revealed 4 L of blood. She underwent a myomectomy and subsequently, an angiogram and embolization of a bleeding uterine artery. In all, she required transfusion of 26 units of blood. Post operatively she was discharged home on hospital day 13.

DISCUSSION

Near fatal hemoperitoneum secondary to a uterine leiomyoma may be due to traumatic or spontaneous rupture of an overlying vein or artery. Leiomyomas greater than 10 cm in size have an increased risk of rupturing. A significant amount of blood can accumulate in the peritoneum resulting in hypovolemic shock.

CONCLUSION

Acute complications of uterine leiomyomas requiring surgical intervention are exceptionally rare. Candidates for the massive transfusion protocol must be appropriately and timely identified. Additionally, because surgery is a potential treatment for hemorrhage control in leiomyoma-related hemoperitoneum, surgeons should be aware of such complications.

Authors+Show Affiliations

Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States. Electronic address: Adel.Elkbuli@HCAHealthcare.co.Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31326857

Citation

Elkbuli, Adel, et al. "Life-threatening Hemoperitoneum Secondary to Rupture of a Uterine Leiomyoma: a Case Report and Review of the Literature." International Journal of Surgery Case Reports, vol. 61, 2019, pp. 51-55.
Elkbuli A, Shaikh S, McKenney M, et al. Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature. Int J Surg Case Rep. 2019;61:51-55.
Elkbuli, A., Shaikh, S., McKenney, M., & Boneva, D. (2019). Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature. International Journal of Surgery Case Reports, 61, 51-55. https://doi.org/10.1016/j.ijscr.2019.07.004
Elkbuli A, et al. Life-threatening Hemoperitoneum Secondary to Rupture of a Uterine Leiomyoma: a Case Report and Review of the Literature. Int J Surg Case Rep. 2019;61:51-55. PubMed PMID: 31326857.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature. AU - Elkbuli,Adel, AU - Shaikh,Saamia, AU - McKenney,Mark, AU - Boneva,Dessy, Y1 - 2019/07/12/ PY - 2019/04/15/received PY - 2019/07/06/accepted PY - 2019/7/22/pubmed PY - 2019/7/22/medline PY - 2019/7/22/entrez KW - Fibroids KW - Hemoperitoneum KW - Massive transfusion protocol KW - Uterine leiomyoma SP - 51 EP - 55 JF - International journal of surgery case reports JO - Int J Surg Case Rep VL - 61 N2 - INTRODUCTION: While uterine leiomyomas are the most common pelvic tumors in females, resultant hemoperitoneum is an extremely rare and acute complication which requires emergent intervention and resuscitation. To date, less than one-hundred cases have been reported in the literature. PRESENTATION OF CASE: We report a case of massive hemoperitoneum due to spontaneous rupture of a 20 cm pedunculated leiomyoma in a 74-year-old female who presented as a trauma alert. Rapidly declining hemodynamic status with an ultrasound consistent with extensive hemoperitoneum led to activation of the massive transfusion protocol and an emergent laparotomy. In the operating theater the laparotomy revealed 4 L of blood. She underwent a myomectomy and subsequently, an angiogram and embolization of a bleeding uterine artery. In all, she required transfusion of 26 units of blood. Post operatively she was discharged home on hospital day 13. DISCUSSION: Near fatal hemoperitoneum secondary to a uterine leiomyoma may be due to traumatic or spontaneous rupture of an overlying vein or artery. Leiomyomas greater than 10 cm in size have an increased risk of rupturing. A significant amount of blood can accumulate in the peritoneum resulting in hypovolemic shock. CONCLUSION: Acute complications of uterine leiomyomas requiring surgical intervention are exceptionally rare. Candidates for the massive transfusion protocol must be appropriately and timely identified. Additionally, because surgery is a potential treatment for hemorrhage control in leiomyoma-related hemoperitoneum, surgeons should be aware of such complications. SN - 2210-2612 UR - https://www.unboundmedicine.com/medline/citation/31326857/Life_threatening_hemoperitoneum_secondary_to_rupture_of_a_uterine_leiomyoma:_A_case_report_and_review_of_the_literature_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(19)30384-0 DB - PRIME DP - Unbound Medicine ER -
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