title: An unusual presentation of a ruptured degenerative fibroid in a perimenopausal woman.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Meei Jiun
authors.initials: MJ
authors.lastname: Seet
authors.affiliation: Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Sonali
authors.initials: S
authors.lastname: Chonkar
authors.affiliation: Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore.
authors.forename: Manisha
authors.initials: M
authors.lastname: Mathur
mesh_terms: D000005:Abdomen / Q000473:pathology*; D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D047648:Perimenopause; D012421:Rupture; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014599:Uterus / Q000473:pathology*