title: Intraperitoneal haemorrhage secondary to perforation of uterine fibroid after cystic degeneration. Unusual CT findings resembling malignant pelvic tumor: case report.
abstract: Intraperitoneal haemorrhage is a rare complication of myomatous uterus. We present a case of a 37-year-old white nullipara who presented in the emergency room with acute, lower-abdominal pain which reportedly started after riding over a bump on a motorcycle. On examination, the abdomen was diffusely tender, with moderate spasm and rebound tenderness in both iliac fossae. Pregnancy test was negative. Computed tomography revealed a soft-tissue mass with cystic components and inhomogeneous appearance. Free fluid in the peritoneal cavity suggested ascites. The patient underwent an exploratory laparotomy. A ruptured, actively bleeding, subserosal, nonpedunculated, cystic degenerated uterine fibroid was found, as well as approximately two liters of free, bloodstained peritoneal fluid and clots. Subtotal hysterectomy without salpingo-oophorectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, definitive, preoperative diagnosis of a perforated, haemorrhaging, uterine fibroid is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
authors.affiliation: Department of Gynaecology, George Gennimatas General State Hospital of Athens, Second District National Health System, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Varras
authors.forename: S
authors.initials: S
authors.lastname: Antoniou
authors.forename: Ch
authors.initials: Ch
authors.lastname: Samara
authors.forename: S
authors.initials: S
authors.lastname: Frakala
authors.forename: Z
authors.initials: Z
authors.lastname: Angelidou-Manika
authors.forename: P
authors.initials: P
authors.lastname: Paissios
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006465:Hemoperitoneum / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D007889:Leiomyoma / Q000150:complications*; D012422:Rupture, Spontaneous / Q000150:complications; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000150:complications*