Case report of spontaneous hemoperitoneum secondary to uterine myomatosis and adenomyosis

Abstract

Introduction

Myomatosis and uterine adenomyosis are the most common benign uterine pathologies suffered by women of reproductive age and the symptoms they produce are mainly abnormal vaginal bleeding, dysmenorrhea and pelvic pain, but they are rarely associated with spontaneous peritoneal bleeding. The existence of this entity and its etiology is little known in the literature, limited to case reports, generating a difficulty in diagnosis. The objective of this article is to report an infrequent case of spontaneous hemoperitoneum secondary to uterine myomatosis and adenomyosis.

Main symptoms

Prior informed consent and certification from the institution's ethics committee. This is a 50-year-old Colombian patient, in a state of symptomatic perimenopause with hormone replacement therapy, who came to the emergency department with a history of pain in the lower abdomen of three days of severe intensity, only associated with diarrhea.

Main diagnoses

Abdominal computed tomography and transvaginal ultrasound diagnosed hemoperitoneum associated with a probable left adnexal mass, suggestive of a ruptured hemorrhagic cyst.

Therapeutic interventions and results

Exploratory laparoscopy was performed and identify hemoperitoneum secondary to a highly vascularized subserosal fibroid with bleeding from its base, hypervascularized uterus, without obvious ovarian pathology, associated with multiple adhesions between the fibroid, uterine tube and ipsilateral ovary. Due to the patient's age and continuous uncontrolled bleeding, it was decided to perform a total hysterectomy plus unilateral left salpingo-oferectomy.

Conclusion

This case demonstrates that, although extremely rare, uterine fibroids (still coexisting with adenomyosis) can cause spontaneous hemoperitoneum. It is essential to consider this diagnosis within the acute gynecological abdomen, since timely recognition and treatment improve the prognosis.