A Case of Hemoperitoneum Due to Spontaneous Bleeding from a Uterine Leiomyoma.

BACKGROUND Uterine leiomyoma, or uterine fibroid, is the most common gynecologic neoplasm and its management usually results in a good clinical outcome. This report is of a rare case of hemoperitoneum associated with spontaneous hemorrhage from a benign uterine leiomyoma. CASE REPORT A 27-year-old single woman presented with generalized acute abdominal pain and vomiting. Clinical examination showed a distended abdomen and unstable vital signs. Following active resuscitation, ultrasound and computed tomography (CT) imaging showed an intraperitoneal fluid collection and heterogenous uterine mass. The patient underwent emergency laparotomy with the identification of bleeding blood vessels, which were clipped, resulting in hemostasis. The uterine lesion was completely excised and histopathology confirmed the diagnosis of benign leiomyoma. The patient's postoperative course was unremarkable. Five days following admission, the patient was discharged from hospital without further complications. CONCLUSIONS Hemoperitoneum secondary to spontaneous hemorrhage from a benign uterine leiomyoma is rare. This case demonstrates that clinical history, imaging, and surgical exploration are required to identify and control the source of bleeding to prevent a potentially fatal outcome.

Prevalence of Metabolic Syndrome Among the End-Stage Renal Disease Patients on Hemodialysis.

BACKGROUND: Patients with metabolic syndrome (MetS) have a 2.6-fold greater risk of incident chronic kidney disease (CKD). The primary goal of this study was to assess the prevalence of MetS in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD) and the impact of MetS presence on HD-related outcomes. METHODS: This is a cross-sectional study conducted in the Dialysis Center, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia. It was conducted among ESRD patients that attended the Dialysis Center between August 2013 and September 2016. We excluded patients on peritoneal dialysis and those < 18 years old. We used the International Diabetes Federation (IDF) criteria to identify patients with MetS. RESULTS: A total of 241 patients with ESRD on HD were found, with a mean age of 48.8 (SD 16) years, mean body mass index (BMI) of 25.6 (SD 8.7) kg/m2, and mean waist circumference (WC) of 92.0 (SD 23.5) cm. The mean duration of the HD was 69.3 (SD 65.6) months with arteriovenous fistula (AVF) as the most common access for HD. Of the patients, 38.2% had MetS. Compared to those without MetS, those with MetS were more likely to be older (P < 0.001), be female (P < 0.001), be married (P < 0.001), have higher BMI (P < 0.001), have larger WC (P < 0.001), have T2D and hypertension (HTN) (P < 0.001), have shorter HD duration (P < 0.001), have a longer duration since the AVF was placed (P = 0.026), and have high post-HD creatinine levels (P = 0.010) and were less likely to have adequate HD (P = 0.004) and have parathyroid hormone (PTH) at goal (P = 0.046). CONCLUSION: MetS is common among ESRD and MetS was associated with more comorbidity, worse anthropometric measures at baseline, and worse HD-related outcomes. The limitations were small sample size and single center.