Case Report: Massive Hemoperitoneum Due to Ruptured Superficial Vein Overlying a Pedunculated Fibroid: A Rare Case Report

Abstract Background Uterine fibroids, also known as leiomyomas, are the most common benign tumors in reproductive-aged individuals. Although they may remain asymptomatic, they can occasionally lead to acute complications, including sudden hemorrhage. Spontaneous hemoperitoneum due to fibroids is extremely rare and can be life threatening. Case Presentation We report the case of a 48-year-old multiparous woman with a history of hypertension who presented to the emergency department with acute abdominal pain, vomiting, and hypovolemic shock. An emergency computed tomography (CT) scan showed a large hemoperitoneum and a uterine mass measuring 10 cm. Emergency laparotomy revealed a pedunculated fundal fibroid with an actively bleeding superficial vein. Myomectomy was performed, followed by hemostatic control and abdominal washout. The patient required blood transfusion and recovered well without further complications. Histopathological examination confirmed the diagnosis of a benign leiomyoma. Conclusion Hemoperitoneum due to rupture of a superficial vein overlying a fibroid is an exceedingly uncommon but serious condition demanding prompt diagnosis and surgical management. Clinicians should consider this condition in patients with an acute abdomen and hypovolemic shock, especially in those with known fibroids. Early detection and timely surgical intervention are vital for achieving favorable outcomes.