Life-threatening spontaneous uterine rupture in a non-gravid, unscarred uterus of a nulliparous woman: A case report.

Spontaneous uterine rupture is a rare, life-threatening condition typically seen in gravid women with a history of uterine surgery or trauma. This report presents an unusual case of spontaneous uterine rupture in a 29-year-old virgin, highlighting the critical importance of early diagnosis and intervention, even in the absence of typical risk factors. A 29-year-old nulliparous woman presented with acute onset of severe lower abdominal pain during menstruation. She had no history of sexual activity, uterine surgery, or trauma. A high index of suspicion for spontaneous uterine rupture was raised following a computed tomography (CT) scan. An emergent exploratory laparotomy revealed a rupture at the uterine fundus with extensive necrosis, necessitating a total hysterectomy. Histopathological examination confirmed adenomyosis with significant hemorrhage and vascular thrombosis, without evidence of infection or malignancy. Subsequent investigations identified protein-S deficiency, which may have contributed to a hypercoagulable state. This combination of factors led to localized ischemia and structural compromise of the uterine wall, ultimately leading to spontaneous rupture. This case underscores the importance of considering spontaneous uterine rupture in the differential diagnosis of acute abdominal pain in women, regardless of conventional risk factors. The coexistence of adenomyosis and protein-S deficiency might have synergistically contributed to uterine wall compromise and rupture. Early recognition and prompt intervention are essential to prevent severe complications, and evaluation for underlying coagulopathies should be considered to guide management and reduce the risk of adverse outcomes.