Document Type : Case Report


Department of Emergency and Trauma, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia


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


Main Subjects

1. Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. Lippincott Williams & Wilkins; 2013.
2. da Silva CM, Luz R, Almeida M, Pedro D, Paredes B, Branco R, et al. Hemoperitoneum during pregnancy: a rare case of spontaneous rupture of the uterine artery. Case Rep Obstet Gynecol. 2020;2020:8882016. doi:10.1155/2020/8882016.
3. Swaegers MCR, Hauspy JJ, Buytaert PM, De Maeseneer MG. Spontaneous rupture of the uterine artery in pregnancy. Eur J Obstet Gynecol Reprod Biol. 1997;75(2):145-6. doi: 10.1016/s0301-2115(97)00121-8.
4. Hardin N, Delozier A, Torabi A, Laks S. Spontaneous rupture of the uterine artery in an otherwise normal pregnancy. J Radiol Case Rep. 2017;11(1):7-13. doi: 10.3941/jrcr.v11i1.2946.
5. Rabie ME, Wali MA. Spontaneous rupture of the uterine artery in a non-pregnant woman. Ann Saudi Med. 2003;23(3-4):177-8. doi: 10.5144/0256-4947.2003.177.
6. Buggio L, Aimi G, Vercellini P. Hemoperitoneum following sexual intercourse in a woman with deep infiltrating
endometriosis. Gynecol Obstet Invest. 2016;81(6):559-62.doi: 10.1159/000447262.
7. Janicki TI, David LJ, SkafR. Massive and acute hemoperitoneum due to rupture of the uterine artery by erosion from an endometriotic lesion. Fertil Steril. 2002;78(4):879-81. doi:10.1016/s0015-0282(02)03348-4.
8. Atkinson PR, McAuley DJ, Kendall RJ, Abeyakoon O, Reid CG, Connolly J, et al. Abdominal and cardiac evaluation
with sonography in shock (ACES): an approach by emergency physicians for the use of ultrasound in patients with
undifferentiated hypotension. Emerg Med J. 2009;26(2):87- 91. doi: 10.1136/emj.2007.056242.
9. Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AA, et al. Abdominal vascular emergencies: US and
CT assessment. Crit Ultrasound J. 2013;5(Suppl 1):S10. doi:10.1186/2036-7902-5-s1-s10.
10. Patterson BO, Holt PJ, Cleanthis M, Tai N, Carrell T, Loosemore TM. Imaging vascular trauma. Br J Surg. 2012;99(4):494-505. doi: 10.1002/bjs.7763.