Mamta Bhat* and Santanu Acharya

A 30-year-old Afro-Caribbean lady with multiple fibroids presented to gynaecology. Since she was keen to maintain her fertility, she was treated conservatively with gonadotrophic releasing agonist hormone (GnRH analogues), ulipristal acetate and uterine artery embolization but the treatments were unsuccessful. Subsequently, she underwent laparotomy and myomectomy of a 22 cm fibroid uterus with massive blood loss, needing blood transfusion. She was readmitted 10 days later, generally feeling unwell with abdominal pain and was noted to be profoundly anaemic. Provisional diagnoses of intra-abdominal bleed, sepsis, degeneration of remaining fibroids was suspected. With the help of multidisciplinary team including the general surgeons and radiologists, she was diagnosed to have ruptured duodenal ulcer and underwent a relaparotomy with under-running of ruptured duodenal ulcers. She made a protracted recovery with further complication of wound abscess. This highlights the importance to consider gastrointestinal bleed from ruptured stress ulcer after major surgery, although rare in gynaecology

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