title: Difficult diagnosis of hemoperitoneum in a patient with a pelvic mass of large size.
abstract: BACKGROUND
  Intraperitoneal hemorrhage caused by a uterine myoma is rare (Tajima et al., 2015).
  
  
  METHODS
  A 47-year-old woman was admitted to the emergency room for worsening abdominal pain. Ultrasound revealed fluid filled almost the entire abdominal cavity as well as the presence of a mass of about 20cm near the uterus. It was not easy to understand the nature of the fluid by ultrasound. It appeared to be ascites with a tumoral pelvic neoformation. On TC there was extravasation of contrast material, but the bleeding site was not identifiable. An emergency operation was performed. Bleeding was from a subserosalmyoma on the anterior wall of the uterus; myoma measured approximately 20cm in maximum diameter. Pathological assessment of the resected specimen revealed bleeding from ruptured tortuous veins on a serosal-type uterine myoma.
  
  
  CONCLUSIONS
  Spontaneous rupture of a vein or an artery overlying a myoma has been documented in English literature on the subject, although it is extremely rare (Tajima et al., 2015).
  
  
  CONCLUSIONS
  The differential diagnosis between ascites and hemoperitoneum is sometimes not easy. Ultrasound is a helpful instrument in expert hands to make a diagnosis of hemoperitoneum. The aid of other diagnostic methods as TC help the clinician to arrive at the correct diagnosis quickly.
authors: Department of Obstetrics and Gynecology, ARNAS Garibaldi Nesima, via Palermo 636, 95124 Catania, Italy. Electronic address: ema333@hotmail.it.
authors: Emanuele
authors: E
authors: Cerruto
authors: Department of Obstetrics and Gynecology, ARNAS Garibaldi Nesima, via Palermo 636, 95124 Catania, Italy. Electronic address: Chiarasudano@hotmail.it.
authors: Maria Chiara
authors: MC
authors: Sudano
authors: Department of Obstetrics and Gynecology, ARNAS Garibaldi Nesima, via Palermo 636, 95124 Catania, Italy. Electronic address: cerrutoemanuele@gmail.com.
authors: Carla
authors: C
authors: Ettore
authors: Department of Obstetrics and Gynecology, ARNAS Garibaldi Nesima, via Palermo 636, 95124 Catania, Italy. Electronic address: giorgiolagreca@gmail.com.
authors: Giorgio
authors: G
authors: La Greca
authors: Department of Obstetrics and Gynecology, ARNAS Garibaldi Nesima, via Palermo 636, 95124 Catania, Italy. Electronic address: michelegiulianolagreca@gmail.com.
authors: Michele Giulano
authors: MG
authors: La Greca
keywords: Hemoperitoneum; Myoma; Uterus; Varicous veins rupture