Acute Cardiovascular Collapse Secondary to Massive Hemoperitoneum from a Bleeding Uterine Fibroid (original) (raw)
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BMC Women's Health
BackgroundAcute abdomen comprises several emergencies. Hemoperitoneum associated with uterine fibroids, which can present as acute abdominal pain, is rare and difficult to diagnose. Especially, spontaneous hemorrhage from the rupture of the superficial vessels overlying a uterine fibroid is extremely rare, and its diagnosis and management have not been established.Case presentationWe report a case of a 55-year-old woman who presented at our hospital with acute abdomen. After performing a computed tomography scan, we conducted a laparoscopic examination and diagnosed hemoperitoneum of ambiguous origin. We treated the patient surgically, performing a laparoscopic myomectomy to remove the origin of the hemorrhage. The patient recovered well.ConclusionsWe report a case of hemoperitoneum of ambiguous origin that was diagnosed laparoscopically and treated by laparoscopic myomectomy to remove the origin of the hemorrhage. Surgeons should rapidly diagnose and manage acute abdominal pain in ...
Rare complication of fibroids in pregnancy: Spontaneous fibroid rupture
Journal of Obstetrics and Gynaecology Research, 2017
Uterine fibroids in pregnancy present with numerous complications. However, spontaneous rupture is a rare and potentially life‐threatening event. We report a case of a 43‐year‐old multiparous woman who presented with hypovolemic shock secondary to a ruptured uterine fibroid 2 days after a spontaneous vaginal delivery. Emergency laparotomy confirmed massive intra‐abdominal hemorrhage from the ruptured capsule of a 10‐cm subserosal fibroid. A myomectomy was performed. Her postoperative recovery period was uneventful. This case is very rare, with fewer than 30 cases of hemoperitoneum secondary to rupture of fibroids having been reported in published works. It demonstrates how a benign and common condition, such as fibroids, can lead to an obstetric emergency that mimics a surgical abdomen requiring swift diagnosis and surgical intervention.
An unusual cause of fetomaternal distress at term: uterine vessel rupture in pregnancy
BMJ Case Reports, 2015
This report describes a case of spontaneous bleeding from uterine vessels presenting as hyperstimulation and fetomaternal distress at term. A 40-week primigravid woman underwent an emergency caesarean section for fetal distress, which unexpectedly revealed a spontaneous haemoperitoneum. Clinical assessment and investigations postoperatively gave a diagnosis of a rightsided uterine artery aneurysm that, it was believed, had ruptured, causing the haemoperitoneum. This was successfully treated postnatally using interventional radiological techniques leading to expeditious maternal recovery and discharge home.
PREGNANCY AFTER UTERINE ARTERIAL EMBOLIZATION FOR THE TREATMENT OF FIBROID - CASE REPORT (Atena Editora), 2022
Leiomyomas are benign tumors which have a high prevalence in the gynecological routine and great economic impact on the health system. Embolization of the uterine artery represents a less invasive therapeutic proposal in the management of myomatosis, but it still faces resistance in its use, especially in women with a desire to become pregnant in the future. In the literature, there is documentation on the safety and efficacy of EAU in the short term, but further studies are needed on its long-term effects, especially in relation to fertility, since there is a risk of damage to the utero-ovarian collateral circulation and consequent local change in blood flow. during the procedure. The aim of the study is to report the case of gestational success after the approach of myomatosis by uterine artery embolization. The work consists of a descriptive study of the case report type, followed at the Centro de Mioma, RJ, and is based on the analysis of medical records. Due to limited studies on the effects of EAU in the long term, it was not possible to establish the superiority or advantage of the EAU in relation to other therapeutic methods, as well as it was impossible to identify individual and/or external factors that contribute to a greater chance of the patient to preserve her fertility. More scientific studies are needed to assist in choosing the most beneficial invasive leiomyoma treatment method for each woman, especially nulliparous women.
Annals of African Medicine, 2011
Abdominal Compartment Syndrome (ACS) is characterized by intra-abdominal hypertension (IAH), elevation and splinting of the diaphragm, high pleural pressure, and poor venous return to the heart, producing low cardiac output and shock which, in turn, results in poor venous return across the capillaries to set in a vicious cycle. Unless the Intra-abdominal pressure is reduced quickly by urgent surgical or medical interventions, death is inevitable. We report a case of ACS resulting from an unrecognized slow but massive intra-abdominal bleeding caused by a ruptured ectopic pregnancy (REP) in an Arab woman. Due to the unusual nature of the presentation of the REP, the diagnosis proved elusive for over a week until the patient succumbed to hypovolemic shock after losing about 4.2 l inside the peritoneal space. The fruitless effort at aggressive fl uid resuscitation was at operation found not due to hypovolemia per se but due to IAH causing ACS. The lessons learned from this case emphasize the need for awareness about atypical presentations of REP and the need for quick intervention to terminate the vicious cycle of ACS.
Cureus, 2022
Hemoperitoneum as a result of uterine rupture in a previously unscarred uterus is a rare entity to encounter and a potentially life-threatening condition. Ruptures can occur in a scarred uterus either spontaneously, due to operative manipulations, or with the use of uterotonic medications. In an unscarred uterus, spontaneous ruptures are known with high parity, use of oxytocin, and prolonged, neglected labor. Ruptures can be silent with no symptoms resulting in a delay in diagnosis and a near-miss situation. Here, we report the case of a 25-year-old young female who was referred to our tertiary care hospital in rural central India six hours after full-term vaginal delivery, which was followed by pain in the lower abdomen. She had no history of cesarean section, laparoscopic procedures, or surgical termination of pregnancy, which would have predisposed her uterus to rupture. She was severely pale on arrival, and a contrast-enhanced computerized tomography scan revealed rupture of the left side of the uterus with hemoperitoneum and a large pelvic hematoma. Because the patient was in hemorrhagic shock, she was immediately taken for laparotomy with simultaneous resuscitative measures and blood transfusion on flow. Extensive uterine rupture, extending through the cervix to the round ligament of the left side involving the left lateral uterine wall, with active bleeding from the site of the defect was confirmed. The hematoma was 10 × 10 cm in size and was evacuated, following which peripartum hysterectomy was done. The left ureter was traced and safeguarded while applying the clamp on Mackenrodt's ligament. The patient recovered completely following the procedure. She was discharged on day 13 in stable condition. She is currently doing well on follow-up and is a good example of a maternal near miss. In this report, we emphasize that, even in the absence of any obvious risk factor, uterine rupture can occur during labor, and monitoring the vitals of patients in the immediate postpartum period is essential to detect and promptly manage this serious condition for preventing maternal mortality.
Bhutan Health Journal, 2017
Spontaneous rupture of an unscarred uterus during pregnancy and labor leading to massive hemoperitoneum is a rare occurrence but with significant morbidity to the mother and fetus. Oxytocin use in labour is a known risk factor for rupture of unscarred uterus. A 21-year-old primigravid woman at 39 weeks of gestation with no known risk factors had labor augmented with an oxytocin infusion; she developed tachysystole and delivered vaginally. Two hours postpartum, pallor, abdominal distension, and a dramatic fall in hemoglobin were noted. An abdominal ultrasound revealed a massive amount of free fluid. At emergency laparotomy the hemoperitoneum was confirmed, and rupture of the posterior wall of the uterus was discovered. Repair of the site of rupture, blood transfusion, and intensive care resulted in a satisfactory recovery. When hemoperitoneum develops in the postpartum period, uterine rupture should be strongly suspected, particularly when oxytocin has been utilized during labor. Jud...