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Bleeding from uterine leiomyoma is a rare cause of hemoperitoneum. In most cases bleeding is a result of trauma or torsion. Spontaneous rupture of a superficial vein is extremely rare. Fewer than 100 cases have been reported. Our patient is a 44-year-old black woman who presented in the emergency room with acute onset of epigastric pain. Past medical and surgical history was not contributory except for a uterine "fibroid." In the emergency room, the patient's abdomen became diffusely tender. Her pregnancy test was negative, and the abdominal ultrasound showed fluid in the peritoneal cavity. The patient became hemodynamically unstable, and there was a significant drop of the hemoglobin/ hematocrit. A surgical consultation was requested, and the patient underwent exploratory laparotomy. A subserosal uterine leiomyoma was found, with an actively bleeding vein on its dome. The leiomyoma was excised and 3 liters of blood and blood clots were evacuated from the peritoneal cavity. The patient was premenopausal and had a known leiomyoma. The clinical course was similar to that of previously reported cases. Although extremely rare, when there is no history of trauma, pregnancy, or other findings, spontaneous bleeding from uterine leiomyoma should be in the differential diagnosis. Emergent surgical intervention is recommended to establish the diagnosis and stop the hemorrhage.
UTERINE LEIOMYOMAS ARE common tumors in women. They are diagnosed clinically in 20 to 30 per cent of females older than 30 years of age and can be seen in up to 75 per cent of hysterectomy specimens when systematically searched for.1,2 Massive intraperitoneal hemorrhage is a very rare complication, and fewer than 100 cases have been reported. The first case was reported by Von Rokitansky3 in 1861 as an autopsy finding. The patient died from peritoneal bleeding. Von Rokitansky wrote, "A tear of a subserosal vein in a fibroid led to hemorrhage into the peritoneal cavity."3 In most cases, there is a history of torsion, hard work, or trauma. Spontaneous bleeding without any increase of the intraabdominal pressure is extremely rare.4 As in the first reported case, the bleeding is almost always venous. In few cases there was a history of arterial bleeding, and hypertension was thought to be the etiological factor.4 All patients who survived had undergone emergent laparotomy. Because of the...