November 30th, 2023

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Acute Hemorrhagic Shock from Prolapsing Myoma Requiring Emergent Surgical Management A Case Report
Authors:  Nicholas Stansbury, M.D., Jun Song, M.D., and Erin Nelson, M.D.
BACKGROUND: Leiomyomas (fibroids) are common benign uterine tumors with varying symptomatology. Fibroids can prolapse, resulting in acute bleeding. Hemorrhagic shock is an extremely rare but life-threatening complication of fibroids.

CASE: A 40-year-old, multiparous woman presented to the emergency department in acute hemorrhagic shock. She was hemodynamically unstable, with a heart rate of 167 and undetectable blood pressure. She was stabilized with transfusion of 3 units of packed red blood cells. Examination revealed an enlarged uterus (to the umbilicus), 200 cc of bright red blood per vagina, and a 10-cm mass filling the vagina with no palpable cervix, consistent with a prolapsing fibroid. Ultrasound confirmed a 12×10-cm prolapsing fibroid. While in the emergency room she continued bleeding and required additional blood products. The patient was urgently taken to the operating room for surgical management. She under-went a total abdominal hysterectomy and required 1 unit of packed red blood cells and fresh frozen plasma intraoperatively. The postoperative period was uneventful, with complete recovery.

CONCLUSION: Hemorrhagic shock from prolapsing fibroid is a rare, life-threatening complication of fibroids. It should be considered in all patients with acute vaginal bleeding and discussed as a potential complication in patients with a known fibroid.
Keywords:  hemorrhagic shock, leiomyomas, prolapsing fibroid, transfusion, uterine fibroids, uterine leiomyomas
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