The management of torsion of huge pedunculated fibroid in 19 weeks pregnant in a low-income country, a case report

Introduction and importance

Fibroids are common benign neoplasms of the uterus, exciting in >70% of women. Also, in 0.3–15% of pregnant. They are classified into submucosal, intramural, and subserosal. The diagnosis depends on ultrasound imaging, while the treatment depends on surveillance, drugs, and surgery.

Case presentation

A 43-year-old nulligravida at 19 weeks’ gestation complained of increased unresponsive subacute pain that started for 3 weeks. She was apprehensive and pale and had digestive disturbances. The physical examination showed tenderness, and the size of the uterus was equivalent to 36 weeks. The radiological investigations showed a live fetus and a well-defined subserosal fibroid measuring 20 × 19 cm, connected to the uterus by a peduncle with torsion signs on echo-Doppler. A myomectomy was done and we had good outcomes for both the mother and fetus.

Clinical discussion

Many factors get together and make our case extraordinary; the rapid increase in size, the size of the fibroid, the pregnancy, the torsion, and the lack of equipment in our area that forced us to treat the patient urgently by laparotomy, which had risks on both the mother and the fetus.

Conclusion

This case highlights that even though laparoscopy is the best choice to treat fibroids during pregnancy; laparotomy is a good choice and has good outcomes for both the mother and the fetus in low-income countries. In addition, Fast diagnosis and treatment also are important to get the best results, especially in complicated situations.