Emergency myomectomy for massive acute hemoperitoneum from avulsion of subserous uterine myoma following a fall: a case report

Uterine fibroids (myomas) are benign tumours commonly seen in women of reproductive age. The cause is generally
unknown but it is associated with ovarian steroids. Uterine fibroids are usually asymptomatic but when they do, they
usually heavy menstrual bleeding and pelvic pain. Diagnosis is usually made from clinical assessment, ultrasound
scanning and histopathological assay of surgical specimens. The treatment can be either medical or surgical.
Massive acute haemoperitoneum from the avulsion of subserous uterine myoma is rare. We had a 32-year-old
nulliparous woman with acute abdomen, massive haemoperitoneum and hypovolaemic shock from the avulsion of a
subserous uterine myoma of a 30-week size uterus following a fall on the abdomen. Her pulse was not palpable on
presentation, blood pressure was 80/40 mmHg and she was pale with a packed cell volume of 16%. She was
conscious but restless. Emergency ultrasound revealed massive haemoperitoneum and multiple uterine fibroids. She
was stabilized and had emergency myomectomies for an unusual uterine fibroids presentation hence the case report. Thirty - three fibroid masses were enucleated. The estimated total blood loss was 4 litres. She was transfused with seven units of blood. She did well post-operation with a packed cell volume of 36% and was discharged home in good condition. The patient is being carefully followed up for possible spontaneous pregnancy as post-surgery HSG was normal with good dye spillage bilaterally. Emergency myomectomy is a life-saving procedure. However,
elective myomectomy is advised for huge uterine fibroids to obviate the risk of traumatic complications.