Endometriosis-induced intra-abdominal bleeding due to hysteroscopic myomectomy: A case report

Yuichiro Kato, Toma Mizoguchi, Ryuichiro Yano
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2021 · vol. 37(1) , pp. 190–193 · doi:10.5180/jsgoe.37.1_190 · W3167845577
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-08 ⓘ

This case report details a 41-year-old woman with endometriosis-induced bleeding undergoing hysteroscopic myomectomy and laparoscopic adnexal resection for dysmenorrhea and anemia.

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This Japanese case report describes a 41-year-old with dysmenorrhea and anemia whose MRI showed a left endometriotic cyst and a submucosal uterine fibroid; she received 3 months of pseudomenopausal therapy before undergoing hysteroscopic myomectomy followed by laparoscopic adnexal resection. During hysteroscopic removal of the 48 mm myoma (67 g), intra-abdominal bleeding was later observed, extending to the liver surface, and its source was identified laparoscopically as rupture of the broad ligament from an endometriotic lesion; estimated hemorrhage was 900 mL. A limitation explicitly inherent to a case report is that findings cannot be generalized beyond this single patient, and transabdominal ultrasonography performed after hysteroscopy could not identify the bleeding source. This paper is centrally about endometriosis — it reports endometriosis-related intra-abdominal bleeding occurring during hysteroscopic myomectomy.

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Abstract

CASE: A 41-year-old gravida 1, para 1 presented with dysmenorrhea and anemia. Magnetic resonance imaging revealed a left-sided endometriotic cyst (45 mm) and a submucosal uterine fibroid (48 mm). She underwent hysteroscopic myomectomy and laparoscopic adnexal resection, following 3-month pseudomenopausal therapy.
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症例報告 子宮鏡下子宮筋腫摘出術中に子宮内膜症病変から腹腔内出血を生じた1例 2021 年 37 巻 1 号 p. 190-193 詳細 抄録 CASE: A 41-year-old gravida 1, para 1 presented with dysmenorrhea and anemia. Magnetic resonance imaging revealed a left-sided endometriotic cyst (45 mm) and a submucosal uterine fibroid (48 mm). She underwent hysteroscopic myomectomy and laparoscopic adnexal resection, following 3-month pseudomenopausal therapy. Hysteroscopic surgery involved fragmentation and removal of the myoma, which weighed 67 g. Subsequently, we performed laparoscopic surgery, and intraoperatively we observed intra-abdominal bleeding that extended to the liver surface. The source of bleeding was identified as the ruptured broad ligament. We performed left adnexal resection after satisfactory hemostasis was achieved. The estimated intraperitoneal hemorrhage was 900 mL. Transabdominal ultrasonography performed upon completion of hysteroscopic surgery could not identify the source of intra-abdominal bleeding. However, subsequent immediate laparoscopic surgery successfully detected the bleeding source. Hysteroscopic myomectomy should be performed cautiously in patients with endometriosis. © 2021 日本産科婦人科内視鏡学会

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endometriosisdysmenorrhea

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