Rupture of a subserosal vein overlying a leiomyoma causing hemoperitoneum

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

Research output: Contribution to journalArticle

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

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Hemoperitoneum
Leiomyoma
Rupture
Veins
Hemorrhage
Thrombosis
Adenomyosis
Iliac Vein
Precipitating Factors
Acute Abdomen
Fallopian Tubes
Hysterectomy
Tachycardia
Cervix Uteri
Laparotomy
Infertility
Abdominal Pain
Sutures
Physical Examination
Uterus

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Surgery

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Rupture of a subserosal vein overlying a leiomyoma causing hemoperitoneum. / Nemer, Laurice Bou; Gaudenti, Dawn; Schroeder, Eric D.; Norris, Paul.

In: Journal of Gynecologic Surgery, Vol. 30, No. 6, 01.01.2014, p. 367-369.

Research output: Contribution to journalArticle

Nemer, Laurice Bou ; Gaudenti, Dawn ; Schroeder, Eric D. ; Norris, Paul. / Rupture of a subserosal vein overlying a leiomyoma causing hemoperitoneum. In: Journal of Gynecologic Surgery. 2014 ; Vol. 30, No. 6. pp. 367-369.
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AB - 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)

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