Acute Cardiovascular Collapse Secondary to Massive Hemoperitoneum from a Bleeding Uterine Fibroid

Background: This case report illustrates that spontaneous vascular rupture in a fibroid can cause acute cardiovascular collapse, and that this should be borne in mind in the differential diagnosis of acute abdomen, especially in the presence of an abdomino-pelvic mass. Case: A 41-year-old nullipara presented in the Casualty Department at Obafemi Awolowo University Teaching Hospitals Complex with a 5-hour history of severe abdominal pain, dizziness, and fainting attack. She was in hypovolemic shock with generalized peritonitis. After resuscitative measures, an emergency exploratory laparotomy was performed. It revealed a ruptured big blood vessel at the top of a 30-week-sized uterine fibroid and 2 L of hemoperitoneum. The vessel was ligated, and 2 units of blood were transfused intra-operatively. The patient had an emergency myomectomy. Results: Her postoperative recovery was uneventful. Conclusions: Sudden rupture of a vascular supply to a uterine fibroid can mimic acute ruptured ectopic pregnancy. (J GYNECOL SURG 28:40). © 2012, Mary Ann Liebert, Inc. All rights reserved.