Red degeneration of fibroid presenting with abdominal pain in pregnancy

Uterine fibroids (leiomyoma) are a common presentation in women of reproductive age. However, during pregnancy, red degeneration and torsion of a subserosal fibroid may present with an acute abdomen, creating a diagnostic dilemma. Red degeneration of a fibroid during pregnancy responds to conservative management, whereas torsion of a subserosal fibroid requires emergency myomectomy. The authors present the case of a woman in her early 30s at 21 weeks gestation presenting with acute onset of right-sided abdominal pain. Ultrasound examination confirmed the diagnosis of fibroid degeneration. She was managed conservatively with analgesia and was discharged home uneventfully after 72 hours. This case report illustrates the diagnostic difficulties often encountered in managing abdominal pain during pregnancy complicated by a fibroid uterus.