Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Julia Tan and Shahul Hameed Mohamed Siraj
KK Womens and Children’s Hospital, Singapore
Posters & Accepted Abstracts: Gynecol Obstet
Uterine fibroids are common benign tumors in women. However, acute complications necessitating emergency surgical intervention are rare. We report herein a case of spontaneous rupture of uterine fibroid needing emergency laparotomy and myomectomy. A 30 years old lady, nulliparous, presented to the emergency department with acute onset of lower abdominal pain for one day. She has medical history of hypertension and asthma. Her pregnancy test was negative. On examination, she had diffuse tenderness in the abdomen. A bedside abdominal sonogram revealed a large amount of free fluid. She was stable and went for a CT abdomen and pelvis which showed hemo-peritoneum with source of bleed arising from a large uterine mass that has ruptured. The hemoglobin level initially was 11.6 g/dL. Patient went for emergency diagnostic laparoscopy. Upon entry by laparoscopy, a 9 cm pedunculated sub-serosal uterine leiomyoma was found, with an actively bleeding vein. Decision was made to convert to open myomectomy in view of the active bleeding. The leiomyoma was excised and 1.3 liters of blood and blood clots were evacuated from the peritoneal cavity. The postoperative course was uneventful. Her postoperative hemoglobin level was 7 g/dL. The patient was given 1 U of packed red blood cells and iron injection. Histopathologic review of the specimen revealed a 9 cm fibroid with hemorrhagic areas. Acute complications secondary to fibroids are rare and seldom necessitate emergency surgical intervention. However, prompt recognition of this severe complication is critical for life-saving surgical management. It can be concluded that rupture of uterine fibroid should be included in the differential diagnosis when encountering patient with known uterine myoma and acute abdomen pain. Exploratory laparotomy is both diagnostic and therapeutic in this life-threatening condition.
Julia Tan is an Obstetrician and Gynecologist at KK Women’s and Children’s Hospital in Singapore. Her research interest includes gynecologic surgery, laparoscopy and maternal fetal medicine.
E-mail: julia.tan@mohh.com.sg