A Very Rare Case of Spontaneous Rupture of a Degenerated Uterine Fibroid

Background

Uterine fibroids (leiomyomas) are the most common benign

pelvic tumours in women of reproductive age, affecting up to

70% by the age of 50 [1]. While they typically present with

chronic symptoms such as heavy menstrual bleeding, pressure

effects, or pelvic pain, they can occasionally lead to acute

complications including torsion, infection, or red degeneration.

One of the rarest acute presentations is the spontaneous

rupture of a fibroid, which can result in significant

intraperitoneal hemorrhage and an acute abdomen [2].

Awareness of this rare but serious complication is vital for

prompt diagnosis and life-saving management.

 

Case Presentation

We report the case of a 49-year-old multiparous woman (P4+2)

with a known history of a multi-fibroid uterus. She was under

gynaecology follow-up and awaiting elective hysterectomy. She

presented to the Emergency Department with sudden, severe

lower abdominal pain, associated with nausea and progressive

abdominal distension.

On clinical examination, she appeared pale and uncomfortable,

with a blood pressure of 96/60 mmHg, heart rate of 112 bpm,

and signs of peritonism on abdominal palpation. Her abdomen

was tense and distended with generalized tenderness. Blood

tests revealed hemoglobin of 8.5 g/dL, and an elevated lactate

of 3.2 mmol/L.

A CT abdomen and pelvis with contrast demonstrated a bulky,

fibroid-laden uterus with a large volume of intraperitoneal fluid.

The fluid demonstrated a density of 18 Hounsfield units, suggestive of

blood, raising concern for active intra-abdominal hemorrhage from a

fibroid source.

The patient was taken for emergency exploratory laparotomy.

Intraoperative findings included 1.6 litres of hemoperitoneum and

active bleeding from a ruptured degenerating subserosal fibroid. A

subtotal abdominal hysterectomy was performed. She was transfused

2 units of packed red cells intraoperatively.

Histopathological examination confirmed multiple leiomyomas with areas

of degeneration, haemorrhage, and infarction. Postoperative recovery

was uneventful, and she was discharged on postoperative day five with

appropriate follow-up.

 

Discussion 

Spontaneous rupture of uterine fibroids is an exceptionally rare entity, with an

estimated incidence of <0.05% of fibroid complications [3]. Risk factors may

include rapid fibroid growth, red degeneration, or underlying vascular

abnormalities within the tumour [4].

This case illustrates several important clinical learning points:

• Acute abdomen in women with fibroids should include rupture or

degeneration in the differential diagnosis.

• Early CT imaging can assist in identifying hemoperitoneum and excluding

other causes (e.g., ruptured ectopic, splenic injury).

• Multidisciplinary management and early surgical intervention are essential

in preventing maternal morbidity and mortality.

A literature review by Zhao et al. (2021) described fewer than 50 documented

cases globally, with most requiring surgical intervention and good outcomes

following timely management [5]. However, delays in diagnosis may be fatal,

especially in perimenopausal women where the cause may not be immediately

suspected.

conclusion  

Spontaneous rupture of a fibroid is a rare but potentially life-

threatening complication. Clinicians should maintain a high index of

suspicion in patients with known uterine fibroids presenting with signs

of acute abdomen and hypovolemia. Prompt diagnosis, appropriate

imaging, and rapid surgical intervention are key to ensuring good

outcomes. This case underscores the importance of timely elective

surgical planning in symptomatic fibroid patients to prevent such

emergencies.

 

References

•Smith R et al. Epidemiology of Uterine Leiomyomas. J Obstet Gynaecol Res.

2018;44(3):456–462.

•Walker C, Pelz J. Rare complications of fibroids: A review. Obstet Med. 2020;13(2):97–

101.

•Taguchi T et al. Hemoperitoneum due to spontaneous rupture of uterine fibroids: Case

report and literature review. Int J Gynaecol Obstet. 2019;146(1):111–113.

•Gupta S et al. Degeneration and infarction in fibroids: Imaging clues. Clin Radiol.

2017;72(10):855–861.

•Zhao Y et al. Spontaneous rupture of uterine fibroids: a systematic review of case

reports. Case Rep Obstet Gynecol. 2021;2021:1–8.

Dr. Mohamed Badawy

Specialist Doctor of obstetrics and gynaecology

Mr. Hashem Elhossamy

Consultant of obstetrics and gynaecology

The Dudley Group NHS Foundation Trust