Uterine leiomyoma with spontaneous intraleiomyoma hemorrhage, perforation, and hemoperitoneum in postmenopausal woman: Computed tomography diagnosis
A 55-year-old multiparous postmenopausal woman presented to our emergency department with acute sudden lower abdominal pain for 2 h associated with dizziness. She denied trauma or vaginal bleeding and has no other associated symptoms. Her last menstrual period was 1 year back. Her medical history is significant for uterine fibroids only. On general examination, she had mild pallor. Her vital signs were stable. Abdominal examination revealed distension of lower abdomen with diffuse tenderness and guarding. A firm tender mass was felt arising from the pelvis. Her lab results were within normal limits except hemoglobin level was 10.4 g/dL. CT scan of abdomen and pelvis with intravenous contrast was performed which revealed a large uterine mass arising from the fundus with heterogeneous appearance and active contrast extravasation inside it [Figures and ]. It also showed an evidence of perforation at the fundus and high density moderate-free fluid (hemoperitoneum) [Figures and ]. A repeated hemoglobin level after 2 h was 8.5 g/dL. Therefore, two packed red blood cells were given and the patient was taken emergently to operating room. Laparotomy was done and revealed enlarged uterus with fundal perforation and clot and tissue coming out from the perforation site as well as about 1 L of hemoperitoneum. A total hysterectomy with bilateral salpingo-oophorectomy was performed. The patient recovered after surgery with uneventful postoperative course and discharged home.\nGross pathological examination revealed enlarged uterus measured 15 × 14 × 9 cm. Bisected uterus showed solid mass measured 15 × 12 × 7 cm arising from the fundus with evidence of perforation. On microscopic examination, a cellular leiomyoma with evidence of hemorrhagic infarction is found. No malignant cells were identified. The uterine cervix, fallopian tubes, and ovaries were normal.