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An unusual presentation of a ruptured degenerative fibroid in a perimenopausal woman
  1. Meei Jiun Seet,
  2. Sonali Chonkar,
  3. Manisha Mathur
  1. Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
  1. Correspondence to Dr Manisha Mathur, drmanishamathur{at}


A 55-year-old woman in a perimenopausal state presented with severe suprapubic pain and fever. Physical examination revealed a tender pelvic mass measuring 24 weeks in size. Ultrasound of the pelvis and CT scan of the abdomen and pelvis showed a 12 cm mass arising from the posterior wall of the uterus with irregular margin inferiorly, raising suspicion of a ruptured mass. The patient was treated conservatively and discharged from the hospital with regular simple analgaesia. She had an elective total hysterectomy bilateral salpingo-oophrectomy and frozen section the following week and histology revealed a benign leiomyoma with extensive necrosis. Moreover, intraoperatively, the fibroid was found to have ruptured its capsule. This case illustrates that a ruptured degeneration of uterine leiomyoma should be considered as one of the differential diagnoses for all women presenting with abdominal pain and a large fibroid mass regardless of their hormonal status or age.

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