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Acute Abdominal Pain Caused by a Spontaneous Intramyometrial Hematoma in Type III von Willebrand Disease

Biri, Aydan MD*; Kurdoglu, Mertihan MD; Kurdoglu, Zehra MD; Gultekin, Serap MD§; Gursel, Turkiz MD

doi: 10.1097/01.pec.0000235838.06331.c3
Illustrative Cases

Objectives: To discuss the clinical picture, differential diagnosis and management of a pediatric patient with von Willebrand disease (vWD) presenting with severe abdominal pain caused by an intramyometrial hematoma.

Methods: A 17-year-old girl with type III vWD was admitted to the emergency department with a complaint of severe lower abdominal pain different from her usual dysmenorrhea. She had no history of trauma to the pelvic region or any sexual intercourse. Transabdominal ultrasonography and magnetic resonance imaging revealed an intramyometrial hematoma in anterofundal region of uterus.

Results: A favorable clinical outcome was obtained through a treatment with factor VIII concentrates containing von Willebrand factor which resulted in complete resolution of the sonographic findings within 3 weeks.

Conclusions: Intramyometrial hematoma can be an unusual cause of severe abdominal pain in patients with vWD applying to emergency departments. Especially in adolescence years, when transvaginal sonography could not be performed, transabdominal ultrasonography and magnetic resonance imaging are useful tools for the diagnosis.

*Department of Obstetrics and Gynecology, Gazi University School of Medicine, Ankara, Turkey; †Department of Obstetrics and Gynecology, Cankiri State Hospital, Cankiri, Turkey; ‡Department of Obstetrics and Gynecology, Cerkes State Hospital, Cerkes, Cankiri, Turkey; §Department of Radiology, Gazi University School of Medicine, Ankara, Turkey and ∥Department of Pediatrics, Division of Hematology, Gazi University School of Medicine, Ankara, Turkey.

Address correspondence and reprint requests to Mertihan Kurdoglu, MD, Cankiri Devlet Hastanesi, Kadin Hastaliklari ve Dogum Klinigi, Cankiri, Turkey. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.