Rupture of a subserosal vein overlying a leiomyoma causing hemoperitoneum

Laurice Bou Nemer, Dawn Gaudenti, Eric D. Schroeder, Paul Norris

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Abstract

Background: Leiomyomas are the most common tumors in women of reproductive age but rarely lead to hemoperitoneum. A total of 95 cases of hemoperitoneum associated with uterine leiomyomas have been described in the literature since 1861. Of these, 66 cases were caused by rupture of a subserosal vein overlying a leiomyoma. Despite previous knowledge of the presence of leiomyomas, very few of these cases were diagnosed correctly prior to surgical exploration. Case: A 46-year-old woman presented with acute-onset abdominal pain and bilateral cold and painful feet. A physical examination revealed tachycardia and an acute surgical abdomen. A computed tomography scan showed an enlarged uterus with multiple leiomyomas, as well as a hemoperitoneum of unknown origin. Upon exploratory laparotomy, the origin of the bleeding was found to be a ruptured subserosal vein overlying an anterior leiomyoma, causing ∼1500?mL of hemoperitoneum. An attempt to suture the bleeding vessel was unsuccessful, and a total abdominal hysterectomy was performed. Results: The patient developed a left iliac vein thrombus postoperatively. On postoperative day 16, this patient was stable for discharge and she was placed on therapeutic anticoagulation for 6 months for treatment of the left-iliac thrombus. Pathology testing revealed uterine leiomyomas, with the largest measuring 15?cm, as well as focal adenomyosis, and an unremarkable cervix and Fallopian tubes. Conclusions: Although rare, a bleeding vessel on a leiomyoma should be kept in the differential diagnosis of hemoperitoneum of unclear origin. A careful history should be elicited to search for precipitating factors, and the patient should be advised of the possibility of infertility following the procedure. (J GYNECOL SURG 30:367)

Original languageEnglish (US)
Pages (from-to)367-369
Number of pages3
JournalJournal of Gynecologic Surgery
Volume30
Issue number6
DOIs
StatePublished - Dec 1 2014

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ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology

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