BackgroundThe gynecologic surgeon is rarely involved in the acute presentation of intraabdominal hemorrhage where it is not the result of an extrauterine gestation. Leiomyoma uteri are more commonly associated with chronic hemorrhage when symptoms do occur. The authors report a case of severe hemorrhagic shock associated with a pediculated leiomyoma uteri.CaseA 45-year-old woman with a history of leiomyoma uteri presented to the emergency room in profound shock. Massive intraabdominal hemorrhage associated with the rupture of an aberrant uterine vein is reported. A review of similar cases is also included. Conclusion: Although benign, leiomyomata uteri may be associated with severe life threatening complications. Nonpregnancy related gynecologic etiologies of intraabdominal hemorrhage should be kept in mind when evaluating the patient with hemorrhagic shock. As conservative management of leiomyoma uteri becomes increasingly popular the gynecologic surgeon must be aware of the potential complications of nonsurgical management.