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  • Title: Intraperitoneal haemorrhage secondary to perforation of uterine fibroid after cystic degeneration. Unusual CT findings resembling malignant pelvic tumor: case report.
    Author: Varras M, Antoniou S, Samara Ch, Frakala S, Angelidou-Manika Z, Paissios P.
    Journal: Eur J Gynaecol Oncol; 2002; 23(6):565-8. PubMed ID: 12556108.
    Abstract:
    Intraperitoneal haemorrhage is a rare complication of myomatous uterus. We present a case of a 37-year-old white nullipara who presented in the emergency room with acute, lower-abdominal pain which reportedly started after riding over a bump on a motorcycle. On examination, the abdomen was diffusely tender, with moderate spasm and rebound tenderness in both iliac fossae. Pregnancy test was negative. Computed tomography revealed a soft-tissue mass with cystic components and inhomogeneous appearance. Free fluid in the peritoneal cavity suggested ascites. The patient underwent an exploratory laparotomy. A ruptured, actively bleeding, subserosal, nonpedunculated, cystic degenerated uterine fibroid was found, as well as approximately two liters of free, bloodstained peritoneal fluid and clots. Subtotal hysterectomy without salpingo-oophorectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, definitive, preoperative diagnosis of a perforated, haemorrhaging, uterine fibroid is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
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