Spontaneous Hemoperitoneum From a Ruptured Vessel Overlying a Sub-Serosal Myoma: A Rare and Life-Threatening Emergency in Women.

Spontaneous hemoperitoneum is a rare yet potentially life-threatening condition characterized by the accumulation of blood in the peritoneal cavity without a traumatic cause. It is rare for a uterine leiomyoma to present with a massive hemoperitoneum; only a few cases have been reported in the literature. We present the case of a 41-year-old Ghanaian female with a history of bilateral tubal ligation who presented to the emergency department with syncope and severe abdominal pain. Initial evaluation revealed hypotension, tachycardia, and significant free intraperitoneal fluid on ultrasound. An exploratory laparotomy identified a massive hemoperitoneum secondary to a ruptured vessel overlying a uterine fibroid, necessitating subtotal hysterectomy and bilateral salpingectomy. This case highlights the importance of considering spontaneous hemoperitoneum in women with uterine fibroids who present with acute abdomen and hemodynamic instability.