Spontaneous Rupture of a Huge Subserous Uterine Fibroid Vessel with Massive Hemoperitoneum: A Rare Case of Fibroid

Abstract

Background: Spontaneous rupture is a potentially life-threatening acute complication of uterine fibroid.  It is a very rare clinical diagnosis and hardly presents with massive hemoperitoneum. This is a case of spontaneous rupture of uterine fibroid vessels with massive hemoperitoneum, necessitating prompt surgical intervention and massive transfusion. Case Report: Mrs A. I was a 35year-old Para 1 who presented to the accident and emergency department of the Rivers State University Teaching Hospital (RSUTH) on the 14th October 2021 with a three-month history of amenorrhoea, and 10 hours history of severe lower abdominal pains associated with dizziness. She was in shock and also had abdominal distension and tenderness. Ultrasonography showed massive hemoperitoneum, uterine fibroids and a left adnexal mass.  She had an emergency exploratory laparotomy and the findings were massive hemoperitoneum, a left ovarian cyst and a huge subserous uterine fibroid with an actively bleeding surface vessel. Myomectomy and left ovarian cystectomy were done. She received 5 units of blood perioperatively and had an uneventful post-operative recovery. Conclusion: Spontaneous rupture of uterine fibroid is a very rare clinical condition. It can lead to significant morbidity and mortality if not recognised and managed promptly. Therefore a high index of suspicion is necessary for women with huge uterine fibroids and hemoperitoneum.