BackgroundUterine leiomyomata are frequently associated with uterine bleeding. However, intraperitoneal hemorrhage from these tumors is rare and has not been reported as a cause of mortality.CaseA 42-year-old woman, who had refused recommended surgical treatment of uterine leiomyomata, was admitted with a history of acute abdominal pain that was rapidly followed by cardiac arrest. Cardiopulmonary resuscitation was successful and while the patient was car-diovascularly stable, clinical examination revealed a distended abdomen and pelvic mass extending to the level of the umbilicus. Abdominal ultrasound scan demonstrated a complex fluid-filled mass. An emergency laparotomy was performed that revealed profuse intraperitoneal hemorrhage from the surface of a uterine fibroid. A subtotal hysterectomy was performed. The patient died on the fifth postoperative day because of severe hypoxic brain injury.ConclusionNonsurgical management of uterine leiomyomata has become more popular in recent years. This case illustrates that conservative management is not without complications, which, in rare instances, can have fatal consequences.