Journal of Emergencies, Trauma, and Shock
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Year : 2011  |  Volume : 4  |  Issue : 3  |  Page : 439
Atraumatic spontaneous rupture of the non-gravid uterus


Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego Medical Center, San Diego, California, USA

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Date of Web Publication16-Aug-2011
 

How to cite this article:
Herrera FA, Hassanein AH, Bansal V. Atraumatic spontaneous rupture of the non-gravid uterus. J Emerg Trauma Shock 2011;4:439

How to cite this URL:
Herrera FA, Hassanein AH, Bansal V. Atraumatic spontaneous rupture of the non-gravid uterus. J Emerg Trauma Shock [serial online] 2011 [cited 2021 May 13];4:439. Available from: https://www.onlinejets.org/text.asp?2011/4/3/439/83896


Sir,

Uterine rupture in a non-gravid patient occurs iatrogenically most often from pelvic trauma or spontaneously as a result of uterine leiomyomas, infections, or uterine carcinoma. [1],[2] We report a non-pregnant female with spontaneous uterine rupture unrelated to trauma and unassociated with a pathological etiology.

A 30-year-old female with a history of bronchiectasis was admitted with pneumonia. The G1P0 patient had a dilation and evacuation during a pregnancy two years prior. Despite six months of amenorrhea, serum human chorionic gonadotropin levels confirmed the patient was not pregnant. During her hospital course, the patient began to complain of abdominal pain and developed vaginal bleeding. She subsequently became apneic and hypotensive and went into cardiac arrest. Cardiopulmonary resuscitation was performed and she was intubated. She responded to aggressive fluid and blood product administration. On physical examination, her abdomen was severely distended; her hemoglobin was 3.7 g/dl. A bedside abdominal ultrasonogram demonstrated free fluid in the abdomen and pelvis and the patient was taken emergently to the operating room for exploratory laparotomy [Figure 1].
Figure 1: A 30-year-old, non-pregnant female with acute onset of abdominal pain and hypotension. Bedside ultrasonography shows a large amount of echogenic free fluid throughout the abdomen (arrow)

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Intraoperatively, several liters of blood and clot were removed from the abdomen; all quadrants were packed for hemostasis. A hemorrhaging uterus was found with a tear extending from the fundus posteriorly to the uterine neck. The uterus was repaired primarily with a running locking chromic suture and appeared hemostatic. A biopsy was taken of the uterus. Because the patient had become coagulopathic, acidotic, and hypothermic, the abdomen was packed and left open. The patient remained intubated on vasopressive support and transferred to the intensive care unit. Two days post-operatively, the patient no longer required vasopressors; abdomen closure was performed. The patient remained on ventilator support and dialysis for acute renal failure for several weeks. One month postoperatively, the patient was discharged to home from with full recovery of her renal function. Histopathology showed no evidence of an abnormal pathological process.

Uterine rupture most often occurs during pregnancy or as the result of trauma; the incidence is 0.07%. [1] Congenital uterine anomalies, multiparity, previous uterine myomectomy, cesarean deliveries, fetal macrosomia, labor induction, and uterine trauma increase the risk of uterine rupture. [1],[2] The classic symptoms of uterine rupture include severe abdominal pain, shock, and vaginal bleeding. Abdominal pain is present in 13-60% of cases and vaginal bleeding occurred in 11-67%. [1],[2],[3] Maternal shock from hypovolemia was associated in 29-46% of patients. [1],[2],[3]

Our patient was not pregnant and had no trauma preceding the uterine rupture. Only two previous reports of spontaneous uterine rupture in a non-gravid uterus have been published in the English literature. [4],[5] In one paper, the patient had multiple abdominal operations and deep cauterization of her cervix. [4] The patient in the other report had a fulminant pelvic infection preceding the rupture. [5]

Although rare, atraumatic spontaneous rupture of the non-gravid uterus should be included in the differential diagnosis of an acute abdomen and shock in a non-pregnant female of child-bearing age. Regardless of etiology, spontaneous uterine rupture is a life-threatening emergency that requires immediate resuscitation, identification, and surgical intervention with either primary repair or hysterectomy.

 
   References Top

1.Eden RD, Parker RT, Gall SG. Rupture of the pregnant uterus: A 53-year review. Obstet Gynecol 1986;68:671-4.  Back to cited text no. 1
    
2.Kieser KE, Baskett TF. A 10-year population-based study of uterine rupture. Obstet Gynecol 2002;100:749-53.  Back to cited text no. 2
[PUBMED]    
3.Golan A, Sandbank O, Rubin A. Rupture of the pregnant uterus. Obstet Gynecol 1980;56:549-54.  Back to cited text no. 3
[PUBMED]    
4.Frech HC. Spontaneous rupture of a non-gravid uterus. South Med J 1949;42:1088.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Bornstien FP. Spontaneous rupture of the nonpregnant uterus. Postgrad Med 1952;12:534-6.  Back to cited text no. 5
    

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Correspondence Address:
Fernando A Herrera
Division of Trauma, Surgical Critical Care, and Burns, University of California San Diego Medical Center, San Diego, California
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.83896

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This article has been cited by
1 Spontaneous rupture of the non-gravid uterus
Weng, L.C. and Menon, T. and Hool, G.
BMJ Case Reports. 2013;
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