Publication:

Hemoperitoneum due to spontaneous rupture of venous plexus overlying a fibroid in pregnancy: a case report

Spontaneous venous rupture overlying a fibroid causing hemoperitoneum in pregnancy is uncommon but highly lethal. A 31-year-old woman, second gravida at 32 weeks of gestation, presented with pain abdomen. On examination, she had mild tachycardia and tachypnea; uterus size was 26 to 28 weeks. Ultrasound revealed intrauterine fetal demise and retro-placental clot without free fluid. Induction of labor was initiated, but the patient’s vitals deteriorated. Repeat ultrasound illustrated intra-abdominal free fluid. On emergency laparotomy, the hemoperitoneum was revealed. Stillborn fetus, placenta, and clots of 100 mg were delivered by cesarean section. On exploration, multiple subserous fibroids were seen, and profuse bleeding was noticed from the venous plexus overlying a fibroid in the posterior left lateral wall. The bleeder was held with Green Armitage and ligated. The patient was discharged in satisfactory condition on post-operative day 10. Immediate surgical intervention is the best modality to diagnose and control bleeding.