Objective: Spontaneous uterine artery rupture in a non-pregnant woman is an extremely
uncommon event. To date, there have only been a few cases. Patients often present with
acute abdomen and are hemodynamically unstable.
Case Presentation: A 42-year-old female presented with multiple episodes of syncopal
attack associated with vomiting and generalized abdominal pain. Upon arrival, she was
hypotensive which required aggressive fluid resuscitation with crystalloids and blood
products. Urine pregnancy test was negative. In addition, ultrasound scan showed
free fluid in the abdomen mainly at the splenorenal area and organized clots around
the uterus. Computed tomography of the Abdomen revealed a moderate amount of
hemoperitoneum with hypodense clots at the left para-colic gutter and pelvis. She
underwent an exploratory laparotomy and intraoperatively noted bleeding from left
uterine artery with 1.2 L of hemoperitoneum with no other abnormalities detected.
Intraoperatively, there was an estimated 5 L blood loss which required packed cell and
disseminated intravascular coagulation transfusion. Subsequently, the patient was sent to
intensive care unit where she recovered well and was discharged home 5 days later.
Conclusion: Spontaneous uterine artery rupture is an extremely rare occurrence with high
mortality if there is failure to detect and intervene early