Acute Hemorrhagic Shock from Prolapsing Myoma Requiring Emergent Surgical Management: A Case Report

BACKGROUND: Leiomyomas (fibroids) are common benign uterine tumors with varying symptomatology. Fibroids can prolapse, resulting in acute bleeding. Hem-orrhagic shock is an extremely rare but life-threatening complication of fibroids. CASE: A 40-year-old, mul-tiparous 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. Exam-ination 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 intra-operatively. The postoperative period was uneventful, with complete recovery. CONCLUSION: Hemorrhagic shock from prolapsing fibroid is a rare, life-threatening complication of fi-broids. It should be considered in all patients with acute vaginal bleeding and discussed as a potential complication in patients with a known fibroid.