title: Rare gynaecological emergency: massive intraperitoneal haemorrhage from spontaneous rupture of a superficial vessel on a large leiomyoma.
abstract: Uterine leiomyomas rarely present as gynaecological emergencies. We report a case of a 29-year-old nulliparous woman, with a negative pregnancy test, who presented with collapse and an admission haemoglobin count of 68 g/L. Urgent CT of the abdomen revealed a 14 × 19 × 10 cm uterine fibroid and intraperitoneal free fluid. Emergency laparotomy confirmed massive intraperitoneal haemorrhage from a large serosal vessel on top of a 19 cm subserosal fibroid. A myomectomy was performed, preserving this patient's fertility. Histopathology confirmed a benign leiomyoma with hydropic changes.
authors.affiliation: Department of Obstetrics and Gynaecology, Walsall Healthcare NHS Trust, Walsall, UK.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Gulati
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Srimathy
authors.initials: S
authors.lastname: Raman
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Maheshwari
authors.initials: M
authors.lastname: Srinivasan
authors.affiliation: Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
authors.forename: Shagaf
authors.initials: S
authors.lastname: Bakour
mesh_terms: D004632:Emergency Medical Services; D005260:Female; D059247:Fertility Preservation; D006465:Hemoperitoneum / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012422:Rupture, Spontaneous / Q000150:complications / Q000601:surgery; D012769:Shock / Q000209:etiology*; D013575:Syncope / Q000209:etiology*; D016896:Treatment Outcome; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult
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