Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

2021 ◽  
Vol 14 (10) ◽  
pp. e243465
Author(s):  
Chiamaka Maduanusi ◽  
Sathiyaa Balachandran ◽  
Sahathevan Sathiyathasan ◽  
Kazal Omar
Keyword(s):  
Uterine Leiomyoma ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Haemodynamic Instability ◽  
Hypovolaemic Shock ◽  
Important Differential Diagnosis ◽  
Life Threatening ◽  
Definitive Management

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

scholarly journals Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Mohamed A. Satti ◽  
Carmen Paredes Saenz ◽  
Rubin Raju ◽  
Sierra Cuthpert ◽  
Abed Kanzy ◽  
...  
Keyword(s):  
Literature Review ◽  
Uterine Leiomyoma ◽  
Medical Center ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Uterine Fibroids ◽  
Case Series ◽  
Thromboembolic Disease ◽  
Uterine Leiomyomas ◽  
Prophylactic Anticoagulation

Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE.Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015.Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.

Management of Uterine Fibroid in the Ayurvedic perspective - A Case Study

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Shruti G. Math ◽  
Dr. Padmasaritha K. ◽  
Dr. Ramesh M.
Keyword(s):  
Uterine Leiomyoma ◽  
Benign Tumor ◽  
Uterine Fibroids ◽  
Abnormal Uterine Bleeding ◽  
Reproductive Age ◽  
Unknown Etiology ◽  
Outpatient Departments ◽  
Pressure Symptom ◽  
Pelvic Pressure

Uterine fibroids are commonest benign tumor of the uterus. Histologically this tumor is composed of smooth muscle and fibrous connective tissue, so named as uterine leiomyoma, myoma or fibroma. The cause for some of the most common gynecological problems among women presenting to gynecology emergency and outpatient departments. They are often asymptomatic but they can cause a multitude of symptoms such as abnormal uterine bleeding, a feeling of pelvic pressure, urinary incontinence or retention, or pain. Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman’s menstrual cycle and pelvic pressure symptom.

scholarly journals Inferior epigastric artery pseudoaneurysms

2015 ◽  
Vol 97 (4) ◽  
pp. 255-258 ◽  
Author(s):  
KJ Edwards ◽  
SK Avula ◽  
BDH Babu ◽  
RA England
Keyword(s):  
Computed Tomography ◽  
Imaging Modality ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Clinical Importance ◽  
Surgical Excision ◽  
Haemodynamic Instability ◽  
Inferior Epigastric Artery ◽  
Percutaneous Procedures ◽  
Epigastric Artery

IntroductionInferior epigastric artery (IEA) pseudoaneurysms are recognised complications of abdominal wall procedures, and a variety of approaches including surgical excision and ligation, percutaneous procedures and conservative management have been employed in treating this rare complication.MethodsWe describe a case of an IEA pseudoaneurysm diagnosed on computed tomography (CT) angiography, 14 days following a laparoscopic assisted low anterior resection, which was managed successfully with surgical excision and ligation. A review of the literature identified 32 reports of this complication since 1973 with 69% of cases occurring since 2000.FindingsThe main aetiology of IEA pseudoaneurysm was abdominal surgery (n=20); 65% of cases were attributable to abdominal wound closure or laparoscopic surgery. Two-thirds (66%) of patients presented between 11 and 63 days, and all except 1 case presented with discomfort, abdominal mass or haemodynamic instability. Colour Doppler ultrasonography was the imaging modality of choice (n=18), either alone or in combination with computed tomography and/or angiography. Surgical ligation and excision and percutaneous coil embolisation formed the mainstay of attempted treatments (69%), particularly following treatment failure using an alternative technique.ConclusionsThe incidence of iatrogenic IEA pseudoaneurysms appears to be increasing. Awareness of this rare complication is of clinical importance to avoid excessive morbidity for affected individuals.

scholarly journals High levels of ca125 in a patient with large uterine fibroid.

2020 ◽  
Vol 19 (4) ◽  
pp. 167-170
Author(s):  
Konstantinos Zacharis ◽  
Konstantinos Dafopoulos
Keyword(s):  
Abdominal Mass ◽  
Female Genital Tract ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Caucasian Woman ◽  
Cancer Antigen 125 ◽  
Cancer Antigen ◽  
Present Case Report ◽  
Female Genital

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors of the female genital tract and affect 60 to 80% of women at their reproductive age. Although elevated tumor markers may be measured in benign gynaecological diseases, the association of uterine fibroids with increased levels of serum cancer antigen 125 (CA125) has not been proven to date. In the present case report we present a rare case of a 21-year-old Caucasian woman attended to our outpatient department with hypermenorrhea and pelvic discomfort that was treated for an enlarged intra-abdominal mass with an abnormally high CA-12 (777.3 U/mL).

scholarly journals Shock due to Splenic Injury after Colonoscopy

2017 ◽  
Vol 11 (1) ◽  
pp. 127-133 ◽  
Author(s):  
Erol G. Nallayici ◽  
Reinier de Groot ◽  
René A.A. van Zanten ◽  
Martijn F. Lutke Holzik
Keyword(s):  
Splenic Injury ◽  
Splenic Rupture ◽  
Rare Complication ◽  
Venous Blood ◽  
Good Health ◽  
Therapeutic Modality ◽  
Colon Perforation ◽  
Haemodynamic Instability ◽  
Life Threatening ◽  
Tomography Scan

Colonoscopy is a common and increasingly performed procedure. It is used both as a diagnostic and therapeutic modality. Splenic injury after colonoscopy is a rare, yet life-threatening complication, most often caused by traction on the splenocolic ligament or excessive manipulation during the procedure. Although non-operative treatment is preferred upon splenic injury, early surgical or radiological intervention may be necessary in specific cases, for example in case of haemodynamic instability. A 71-year-old Caucasian man was referred to our emergency room due to shock after colonoscopy 2 days earlier. A computed tomography scan showed splenic rupture with active intra-abdominal, venous blood loss, and microperforation of the colon. An immediate splenectomy and colon repair were performed through laparotomy. After 6 days, the patient was discharged from hospital in good health. Although splenic rupture is a rare complication of colonoscopy, patients with abdominal pain and/or shock should be checked for complications such as splenic injury and colon perforation.

Clinical case the combination of uterine leiomyoma and pregnancy

2017 ◽  
pp. 65-68
Author(s):  
M.V. Makarenko ◽  
◽  
D.O. Hovsieiev ◽  
L.I. Martynova ◽  
K.V. Mesropyan ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
Uterine Leiomyoma ◽  
Clinical Case ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Choice Of Treatment ◽  
Fetal Malformations ◽  
History Of ◽  
Medical Examinations

This article describes the clinical case mix uterine fibroids and pregnancy 11–12 weeks diagnosed with trisomy 21 in the fetus hrosomi. The history of the study of uterine fibroids, current views on the pathogenesis, etiology and treatment. Highlighted describes the practical value that indicates the need for regular preventive medical examinations of women of reproductive age, the importance of planning pregnancy and choice of treatment for fetal malformations and tumors of the uterus. Key words: uterine fibroids, pregnancy, surgery.

Potential Effects of Melatonin on the Development of Uterine Fibroids in Women of Reproductive Age (Review of Literature)

2021 ◽  
Vol 6 (5) ◽  
pp. 45-50
Author(s):  
B. V. Sokolov ◽  
◽  
O. M. Yuzko
Keyword(s):  
Uterine Leiomyoma ◽  
Reproductive Potential ◽  
Uterine Fibroids ◽  
Current Data ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Foreign Literature ◽  
New Approaches ◽  
Long Time ◽  
The Impact

For a long time, Ukraine has been showing negative dynamics between birth and death rates. The demographic situation in any country is an important indicator. Therefore, the issue of women's health and ability to reproduce is significant and urgent. The purpose of the study was to analyze current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. Hyperplastic processes of the uterus in women of reproductive age are among the most common gynecological diseases. Uterine leiomyoma is the most common benign proliferative pathology. The presence of uterine leiomyoma leads to disorders of women's reproductive health, is one of the causes of infertility, in addition, significantly affects the quality of life of the patient due to constant pain, excessive uterine bleeding, dysfunction of adjacent organs. Many studies confirm the unfavorable course of pregnancy and the postpartum period in women with fibroids, namely: complicated pregnancy, reproductive losses, birth defects and postpartum complications. Despite the intensive work of scientists, the implementation of a large number of studies, the pathogenesis to this day remains multifaceted and poorly understood. Results and discussion. After analyzing current data from domestic and foreign literature on provoking factors, etiology and pathogenesis of uterine fibroids, the review article presents data on current opportunities, new approaches to treatment and the impact of this pathology on a woman's reproductive potential. For a long time, the pineal gland with the hormone melatonin has not been studied. During the scientific research, the review of the current domestic and foreign literature on the potential inhibitory effect of melatonin on uterine fibroid cells, and the direct and indirect effect on fertility was reviewed and analyzed. As a result of analysis of experimental and clinical data presented in the literature, it can be argued that melatonin has the ability not only to regulate biological rhythms, but also that it is promising to study metabolic and immunomodulatory effects, as well as antitumor effects, which gives us a chance to reduce surgery of this group of patients. Conclusion. The information presented in the review suggests that melatonin has the potential as a therapeutic agent for clinical trials against uterine leiomyoma in women of reproductive age. Therefore, there is a need to study deeply the etiopathogenesis of uterine leiomyoma and in particular the effect of melatonin on growth, reduction of surgical interventions, the impact on the pre- and postoperative period, and to determine melatonin as a therapeutic drug

scholarly journals Effect of transforming growth factor-β2 on uterine leiomyoma cells proliferation

2015 ◽  
Vol 96 (6) ◽  
pp. 968-970
Author(s):  
N D Muratova ◽  
A A Abduvaliev
Keyword(s):  
Growth Factor ◽  
Cytotoxic Activity ◽  
Uterine Leiomyoma ◽  
Transforming Growth Factor ◽  
Uterine Fibroids ◽  
Uterine Myoma ◽  
Reproductive Age ◽  
Culture Cells ◽  
Transforming Growth Factor Β2

Aim. To study the role of transforming growth factor-β2 in the uterine leiomyoma pathogenesis. Methods. Studies to determine the cytotoxic activity of the transforming growth factor-β2 regarding the temporary cell culture were conducted. The operational material was used from two women of reproductive age with uterine myoma (multiple symptomatic uterine myoma, proliferative type) who underwent hysterectomy. Patients mean age was 43.5±0.57. Obtained temporary culture cells were split into five groups depending on the transforming growth factor-β2 affecting dose (1000, 500, 100, 10 µg/10×106, and culture with no exposure). After incubation living and dead cells were counted at 280 times magnification. The cytotoxic activity was expressed as a percentage of live and dead cells. Results. Total cell death (necrosis) was 23.0% when using factor at the dose 10 µg/10×106 cells, at the dose 100 µg/ 10×106 cells - 34.5%, at the dose 500 µg/10×106 cells - 44%, at the dose 1000 µg/10×106 cells - 59.5%. The most effective vital life suppressing activity of the transformed cells was observed when exposed to transforming growth factor-β2 at the dose 1000 µg/10×106 cells. Conclusion. Transforming growth factor-β2 is capable to suppress the proliferating uterine fibroids growth under certain conditions and the dose, it has a significant dose-dependent cytotoxic effect in respect of the neoplasm.

scholarly journals Torted and Ruptured Wandering Spleen Presenting as a Surgical Emergency in Pregnancy

2004 ◽  
Vol 4 ◽  
pp. 1035-1037 ◽  
Author(s):  
A. Parvaiz ◽  
S. Chandran ◽  
A. Karim ◽  
K. Kumar ◽  
P. Jeffrey ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Splenic Infarction ◽  
Reproductive Age ◽  
Wandering Spleen ◽  
Contributing Factors ◽  
Midline Laparotomy ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Intraperitoneal Bleeding ◽  
Threat To Life

Wandering spleen (WS) is characterised by incomplete fixation of the spleen to its supporting linorenal and gastrosplenic ligaments. It can predispose to life-threatening complications due to torsion of its vascular pedicle, splenic infarction, portal hypertension, and haemorrhage. A 27-year-old, 36-week prima gravida underwent emergency caesarean section for tachycardia and hypotension. A healthy baby girl was delivered. However, she remained shocked despite aggressive fluid therapy and intraoperatively it was noted that there was significant intraperitoneal bleeding and the on-call surgical team was summoned. Midline laparotomy revealed a lacerated, infarcted, hypermobile spleen found with free intraperitoneal bleeding. The unsalvageable spleen was resected and the patient went on to make an excellent recovery. The aetiology of WS is contentious. With an increased frequency among multiparous females of reproductive age, some suggest the hormonal effects of pregnancy as contributing factors. Clinical presentations range from an asymptomatic abdominal mass to acute abdominal pain with hypovolaemic shock. WS poses a serious threat to life due to thrombosis, bleeding, or infarction. Ultrasound scan and CT scan are equally effective in the diagnosis. Patients with asymptomatic WS should be treated with elective splenopexy, however, in the acute presentation, splenectomy is the procedure of choice.

scholarly journals UTERINE FIBROIDS IMPACT ON FERTILITY AND PREGNANCY OUTCOME

2020 ◽  
Vol 2 ◽  
pp. 52-58
Author(s):  
Olena Doroha ◽  
Mykola Iarotskyi ◽  
Iryna Iarotska ◽  
Liudmyla Semeniuk ◽  
Olga Nikitina
Keyword(s):  
Sex Hormones ◽  
Uterine Leiomyoma ◽  
Uterine Fibroids ◽  
Statistical Processing ◽  
Main Group ◽  
Reproductive Age ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Healthy Women ◽  
Obstetric History

The clinical confirmation of the relationship between uterine leiomyoma and female infertility is of interest to scholars. The aim of our research was to study obstetric history and the level of sex hormones in women of reproductive age with leiomyoma. Materials and methods. The main group consisted of 90 women of reproductive age with uterine leiomyoma, the control group - 45 healthy women. Gynaecological and obstetric history, hormone content in peripheral blood and pelvic vessels (estradiol, progesterone) were analysed. Statistical processing of clinical material was performed using Microsoft Excel, Statistica 7.0, and Statistica 8.0 for Windows. Results. The frequency of infertility in the surveyed women with LM was 18.9 %. One in three patients in the main group (33.3 %) did not give birth, which was statistically different from the healthy women group. In this case, 25.6 % of women in the main group did not use any methods of contraception. It was found that 51.11 % of patients with LM had threatened miscarriage in their history, 37.5 % – complicated delivery. Pathological changes in the concentrations of estradiol and progesterone in the preferential blood and blood vessels of women with fibroids have been identified. We have found that the content of sex hormones in the local bloodstream has a reliable relationship with the location of the myomatous node. Conclusion. The obtained results may indicate that leiomyoma contributes to the reduction of fertility. This is evidenced by the fact that women with LM are more likely to have the risk of miscarriage, complicated delivery and delivery by caesarean section, including complicated one. The findings have made a significant contribution to the further development of effective strategies for the prevention and treatment of infertility in women with fibrotic uterine lesions.

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