Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Sep 23;22(1):388.
doi: 10.1186/s12905-022-01970-0.

Successful laparoscopic management of acute abdominal pain due to spontaneous rupture of subserosal vessels overlying a uterine fibroid: a case report and surgical video

Toshimitsu Maemura  1 , Shigeru Fujita #  2 , Noriko Morita  1 , Keiichi Furusawa  1 , Kayo Mitamura  1 , Kenji Nishizawa  1 , Kuniaki Ota #  3
Affiliations
Case Reports

Successful laparoscopic management of acute abdominal pain due to spontaneous rupture of subserosal vessels overlying a uterine fibroid: a case report and surgical video

Toshimitsu Maemura et al. BMC Womens Health. .

Abstract

Background: Acute 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 presentation: We 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.

Conclusions: We 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 women with a history of uterine fibroids to prevent severe morbidity or even mortality. Therefore, laparoscopic surgery is recommended in patients with stable hemodynamics.

Keywords: Acute abdomen; Hemoperitoneum; Laparoscopic myomectomy; Uterine fibroid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Preoperative computed tomography and intra-operative laparoscopy images identifying the hemoperitoneum. a Abdominal contrast-enhanced computed tomography showed a 7.9-cm fibroid (asterisk) and peritoneal fluid with an imaging density suggestive of blood (yellow arrowhead). b Exploratory laparoscopy identified the hemoperitoneum consistent with computed tomography (yellow arrowhead)
Fig. 2
Fig. 2
Intra-operative procedures during the laparoscopy. a Exploratory laparoscopy identified the bleeding site on the superficial vessels overlying the uterine fibroid. b, c Bipolar coagulation forceps were used to obtain hemostasis at the site of hemorrhage. d The uterus was incised with harmonic scalpels to access the uterine fibroid. e, f The uterine fibroid was laparoscopically enucleated, and the uterine defect was completely sutured for hemostasis and reconstructed in a uterine-sparing surgery
See this image and copyright information in PMC

References

    1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–107. doi: 10.1067/mob.2003.99. - DOI - PubMed
    1. Stewart EA. Clinical practice Uterine fibroids. N Engl J Med. 2015;372(17):1646–1655. doi: 10.1056/NEJMcp1411029. - DOI - PubMed
    1. Vilos GA, Allaire C, Laberge PY, Leyland N. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157–178. doi: 10.1016/S1701-2163(15)30338-8. - DOI - PubMed
    1. Dababou S, Garzon S, Laganà AS, Ferrero S, Evangelisti G, Noventa M, et al. Linzagolix: a new GnRH-antagonist under investigation for the treatment of endometriosis and uterine myomas. Expert Opin Investig Drugs. 2021;30(9):903–911. doi: 10.1080/13543784.2021.1957830. - DOI - PubMed
    1. Angioni S, D'Alterio MN, Daniilidis A. Highlights on medical treatment of uterine fibroids. Curr Pharm Des. 2021;27(36):3821–3832. doi: 10.2174/1381612826666210101152820. - DOI - PubMed

Publication types