title: Rare postpartum ruptured degenerated fibroid: a case report.
abstract: Spontaneous rupture of uterine fibroid is rarely encountered. We present a case of a 31-year-old who presented with acute abdominal pain at 9 weeks postpartum. On examination, the abdomen had diffuse tenderness, with rebound tenderness in the suprapubic area and in both iliac fossae. On ultrasonography, a 12.7 × 8.6 × 8.9-cm sized hyperechoic mass was visible on the posterior wall of the uterus. A large amount of fluid was visible in the paracolic gutters and the Pouch of Douglas (POD). The patient underwent an exploratory laparotomy. A ruptured, cystic degenerated uterine fibroid with active bleeding was found, as well as approximately half a liter of free, bloodstained peritoneal fluid and pus. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.
authors.affiliation: Department of Obstetrics & Gynecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
authors.forename: Yiap L
authors.initials: YL
authors.lastname: Tan
authors.forename: Aruku
authors.initials: A
authors.lastname: Naidu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D012422:Rupture, Spontaneous; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: acute abdomen; degenerated fibroid; postpartum; red degeneration