McKendrick Michael, Rajadurai Vinita, Weishaupt Jennifer, Kasina Venkata
Fiona Stanley Hospital, Department of Obstetrics and Gynaecology, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia.
Case Rep Womens Health. 2024 Apr 12;42:e00609. doi: 10.1016/j.crwh.2024.e00609. eCollection 2024 Jun.
Uterine myomas, fibroids or leiomyomas are benign neoplasms that can present as abnormal uterine bleeding and pressure symptoms. Significant complications are infrequent, but they can be life-threatening. This is a case of a ruptured fibroid where excessive intra-abdominal bleeding resulted in hemoperitoneum. In this clinical scenario, timely recognition and intervention were essential to prevent morbidity and mortality. This article discusses the diagnostic challenges and surgical management of a case of hemoperitoneum resulting from spontaneous haemorrhage from a ruptured vessel on the surface of a subserosal leiomyoma. A 42-year-old patient with a known multi-fibroid uterus awaiting elective surgery presented with acute-onset abdominal pain to the emergency department. She had a distended, tender abdomen. Laboratory tests and contrast computerised tomography revealed haemorrhage with no clear source of bleeding. Emergency midline laparotomy revealed active bleeding from the surface of a posterior subserosal leiomyoma with 1950 mL hemoperitoneum. A total abdominal hysterectomy was performed, and the patient had an uncomplicated recovery. The pre-operative haemoglobin level was 80 g/L, which normalized after several blood transfusions. Histopathological examination confirmed multiple leiomyomas and haemorrhage associated with ischaemic changes. Hemoperitoneum from a bleeding degenerating leiomyoma is an exceedingly uncommon complication. The atypical presentation of abdominal pain and the presence of a multi-fibroid uterus posed diagnostic challenges. This case underscores the importance of considering leiomyomas as a potential cause of acute abdominal pain and bleeding. Timely surgical intervention, supported by a multidisciplinary approach, is essential for optimal patient outcome.
子宫肌瘤、纤维瘤或平滑肌瘤是良性肿瘤，可表现为异常子宫出血和压迫症状。严重并发症并不常见，但可能危及生命。这是一例肌瘤破裂的病例，腹腔内大量出血导致腹腔积血。在这种临床情况下，及时识别和干预对于预防发病和死亡至关重要。本文讨论了一例浆膜下平滑肌瘤表面血管自发出血导致腹腔积血的诊断挑战和手术治疗。一名已知患有多发子宫肌瘤且等待择期手术的42岁患者因急性腹痛到急诊科就诊。她腹部膨隆且压痛。实验室检查和增强计算机断层扫描显示有出血，但出血源不明确。急诊正中剖腹探查发现后位浆膜下平滑肌瘤表面有活动性出血，腹腔积血1950毫升。实施了全腹子宫切除术，患者恢复顺利。术前血红蛋白水平为80g/L，经多次输血后恢复正常。组织病理学检查证实为多发平滑肌瘤以及伴有缺血性改变的出血。出血性变性平滑肌瘤导致的腹腔积血是一种极为罕见的并发症。腹痛的非典型表现以及多发子宫肌瘤的存在带来了诊断挑战。该病例强调了将平滑肌瘤视为急性腹痛和出血潜在原因的重要性。在多学科方法支持下及时进行手术干预对于患者获得最佳预后至关重要。
