Hemoperitoneum following a Motor Vehicle Accident in a Patient with 20 Uterine Leiomyomas

Uterine leiomyomas are neoplasms of the smooth muscle that can cause complications such as severe bleeding and infertility in women of reproductive age. While many individuals may be asymptomatic, others may present with anemia secondary to heavy bleeding, cyclical abdominal pain, pelvic pressure, and urinary or bowel symptoms. A rare complication of uterine leiomyomas is avulsion due to blunt abdominal trauma resulting in hemoperitoneum. We present a 49-year-old female with no pertinent medical history who presented to the emergency room following a motor vehicle accident. Computed tomography scan revealed extensive hemoperitoneum and the patient was taken to the operating room where the source of bleeding was identified as multiple avulsed leiomyomas. The patient underwent an emergency hysterectomy and bilateral salpingectomy. Pathology reported a uterus weighing 6,000 g and the presence of 20 leiomyomas, with the largest measuring 29 cm. Knowledge of leiomyoma symptoms, presentation, and complications by both the patient and clinicians may help identify diagnoses and expedite intervention in the emergency setting.