Hemoperitoneum as a result of bleeding from a vein lying on the capsule of subserous leiomyoma of uterus (Clinical case)

Abstract

Leiomyoma is a benign tumor of the uterus and it is considered to be the most sensitive tumor of the female genital organs. The tumor can have submucosal, intramural, and subserosal localizations, each of which has specific features of the course and complications. The article describes the clinical observation of a case of intra-abdominal bleeding, which was caused by the rupture of a vein lying on the capsule of a subserous uterine leiomyoma.Literature data about the leiomyoma frequency and its localization are presented in the article, as well as an explanation of the complexity of the true assessment of the frequency of this pathology, the peculiarities of a described case from a clinical and pathomorphological point of view. A review of the literature allowed to find 125 descriptions of clinical cases of bleeding from the vessel of the subserosal node during the last 100 years.The presented clinical case is interesting from the point of diagnosis. The picture of an “acute abdomen” by leiomyoma is most often associated with a blood circulation disorder of the node, and in this case it was caused by a rupture of a vessel due to twisting of the node and bleeding from the vessel. The patient with a history of subserous leiomyoma of the uterus was hospitalized with complaints of discomfort in the lower abdomen.During the objective examination, an enlarged uterus up to 16 weeks of pregnancy was diagnosed, and during ultrasound examination a leiomyoma node in the uterine fundus, which was twice larger than the uterus size itself, and up to 500 ml of blood in the abdominal cavity were found. During surgery, a subserous node in the uterus fundus with partial torsion was found, the source of bleeding was established – a vein on the posterior wall of the uterus. The patient was operated by conservative myomectomy, histological examination confirmed uterine leiomyoma, the patient was discharged in satisfactory condition.Recent systematic literature reviews have shown that myomectomy is a better surgical procedure compared to hysterectomy, as it reduces the prevalence of shock and blood loss in patients.