Abstract: Uterine fibroid, or leiomyoma, is a common benign neoplasm in women, but serious complications are rarely reported. We present the case of a 48-year-old woman with acute onset of abdominal pain. She was hemodynamically unstable, and computed tomography revealed abundant fluid collection in the peritoneal cavity, suggesting hemoperitoneum. During emergency exploratory laparotomy, the subserosal vein overlying a uterine fibroid was identified as the source of bleeding. Hemostasis was accomplished with fibroid excision. Spontaneous hemorrhage originating from a uterine fibroid is extremely rare, but may lead to life-threatening conditions. Therefore, in female patients with acute abdominal pain and hemoperitoneum, uterine fibroid may be a potential etiology and emergency exploratory laparotomy should be considered.