Article Text

Download PDFPDF
Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain
  1. Clemmie Stebbings1,
  2. Ahmed Latif1 and
  3. Janakan Gnananandan2
  1. 1General Surgery, Lewisham and Greenwich NHS Trust, London, UK
  2. 2General Surgery, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Clemmie Stebbings; clemmie.stebbings{at}


A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

  • obstetrics and gynaecology
  • general surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors CS: First author responsible for drafting and assimilating the case report. AL: Author of the discussion section of the case report. JG: Report supervisor who conceived the report and provided administrative support, technical editing, language editing and proofreading.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.