Unusual presentation of uterine rupture following laparoscopic myomectomy: a case report and literature review

Cassandra P. S. Cheong, Andy W.K. Tan, Lay Kok Tan, Su Ling Yu


Laparoscopic myomectomy is preferred to the laparotomy approach as the former promises a better postoperative course, with fewer complications and faster recovery. It is increasingly performed in younger women in recent years. However, although rare, uterine rupture is an important and dangerous complication. Authors report a case of 36-year-old lady who presented at 23 weeks and 4 days gestation of an in vitro fertilization (IVF) dichorionic diamniotic twin pregnancy with spontaneous uterine rupture. She underwent a laparoscopic myomectomy three year prior for a 4.5cm fundal fibroid. Her presenting symptoms include acute onset of epigastric pain. Uterine rupture was confirmed using Computed Tomography scan. She underwent an exploratory laparotomy and the placenta was found extruding from a 4cm defect on the posterior fundus along the previous myomectomy scar with active bleeding. Current literature suggests it is difficult to predict when uterine rupture may happen. Proper selection criteria for suitable cases may allow trial of labour after myomectomy to be a viable option. Potential considerations include interval between myomectomy and conception, scar integrity, method of repair, and the use of electrocoagulation. This case reports the worrying features of an early antepartum rupture presenting with atypical symptomatology. In pregnant patients presenting with abdominal pain or haemodynamic instability, it is imperative to consider uterine rupture so as to perform timely intervention. Those with a history of laparoscopic myomectomy should be considered high risk and counseled about the risk of rupture with extensive discussion about mode of delivery.



Abdominal pain, Electrocoagulation, In vitro fertilization, Laparoscopy, Myomectomy, Multiple Pregnancy, Trial of labour, Uterine rupture, Uterine scar

Full Text:



Vilos GA, Allaire C, Laberge PY, Leyland N, Vilos AG, Murji A, et al. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015;37(2):157-81.

Li TC, Mortimer R, Cooke ID. Myomectomy: a retrospective study to examine reproductive performance before and after surgery. Hum Reprod. 1999 Jul;14(7):1735-40.

Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand. 2016;95:724-34.

Royal College of Obstetricians and Gynaecologists (RCOG). Birth after previous caesarean birth. Green-top guideline no. 45. 2015. Available at: Accessed 22 Aug 2016.

Dubuisson JB, Fauconnier A. Laproscopic myomectomy. In: Jacques Donnez. Atlas of operative laparoscopy and hysteroscopy. 3rd ed. Informa UK Ltd; 2007. 227-238.

Bulletti C, Polli V, Negrini V, Giacomucci E, Flamigni C. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1996;3,533-6.

Kiseli M, Artas H, Armagan F, Dogan Z. Spontaneous Rupture of Uterus in Mid-trimester pregnancy due to increased uterine pressure with previous laparoscopic myomectomy. Int J Fertl Steril. 2013;7(3):239-42.

Sutton C, Standen P, Acton J, Griffin C. Spontaneous uterine rupture in a preterm pregnancy following myomectomy. Case Rep Obstet Gynecol 2016;2016.

Djaković I, Sabolović Rudman S, Djaković Ž, Košec V. Uterine Rupture Following Myomectomy in Third Trimester. Acta Clinica Croatica. 2015;54.4:521-3.

Song SY, Yoo HJ, Kang BH, Ko YB, Lee KH, Lee M. Two pregnancy cases of uterine scar dehiscence after laparoscopic myomectomy. Obstet Gynecol Sci. 2015;58.6:518-21.

Kacperczyk J, Bartnik P, Romejko-Wolniewicz E, Dobrowolska-Redo A. Postmyomectomic Uterine Rupture Despite Cesarean Section. Anticancer Res. 2016;36(3):1011-3.

Bernardi TS, Radosa MP, Weisheit A, Diebolder H, Schneider U, Schleussner E, et al. Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch Gynecol Obstet. 2014;290(1):87-91.

Tian YC, Long TF, Dai YM. Pregnancy outcomes following different surgical approaches of myomectomy. J Obst Gynaecol Res. 2015;41(3):350-7.

Kumakiri J, Kikuchi I, Kitade M, Kumakiri Y, Kuroda K, Matsuoka S, et al. Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy. Acta Obstet Gynecol Scand. 2010;89(8):1078-83.

Tinelli A, Hurst BS, Mettler L, Tsin DA, Pellegrino M, Nicolardi G, et al. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study. Hum Reprod 2012;27(9):2664-70.

Bujold E, Goyet M, Marcoux S, Brassard N, Cormier B, Hamilton E, et al. The role of uterine closure in the risk of uterine rupture. Obstet Gynecol 2010;116(1):43-50.

Nezhat C, Nezhat F, Bess O, Nezhat CH, Mashiach R. Laparoscopically assisted myomectomy: a report of a new technique in 57 cases. Int J Fertil Menopausal Stud 1993;39(1):39-44.

Seidman DS, Nezhat CH, Nezhat F, Nezhat C. The role of laparoscopic-assisted myomectomy (LAM). JSLS: J Society of Laparoendoscopic Surg 2001;5(4):299.

Hasbargen U, Summerer-Moustaki M, Hillemanns P, Scheidler J, Kimmig R, Hepp H. Uterine dehiscence in a nullipara, diagnosed by MRI, following use of unipolar electrocautery during laparoscopic myomectomy: case report. Hum Reprod. 2002;17(8):2180-2.

Broderick, Stephen R. Hemothorax: etiology, diagnosis, and management. Thoracic Surg Clin. 2013;23(1):89-96.

Vaughan P, Hooper PJ, Duffy JP. Spontaneous hemothorax after caesarian section: an unusual manifestation of diaphragmatic fenestrations. Ann Thoracic Surg 2005;80(4):1517-9.

May J, Ades A. Porous diaphragm syndrome: haemothorax secondary to haemoperitoneum following laparoscopic hysterectomy. BMJ Case Rep. 2013: bcr2013201088.