Pregnancy Complicated by Ruptured Degenerating Leiomyoma and Hemoperitoneum: Case Report

Uterine fibroids are the most common benign gynecologic tumors; in pregnancy, degeneration may occur but is uncommon, whereas spontaneous rupture is an exceedingly rare complication. We present the case of a 43-year-old woman, gravida 2 para 2, at 17 weeks and 6 days of gestation, who was admitted with progressive abdominal pain and distension. Imaging revealed a large degenerating intramural fibroid with hemoperitoneum and a focal contour defect, raising concern for rupture. Despite stable vital signs, the patient experienced spontaneous abortion during hospitalization. Persistent abdominal pain and imaging findings warranted exploratory laparotomy, which revealed approximately 2 L of hemoperitoneum and a ruptured, necrotic fibroid. A uterine-sparing myomectomy was performed, and histopathology confirmed infarct-type degeneration with extensive hemorrhage and necrosis. The postoperative course was uneventful, and the patient was discharged in good condition. This case underscores that fibroid rupture in pregnancy may evolve subacutely, with preserved hemodynamics, and should be considered in pregnant patients with ongoing abdominal pain and degenerating myomas. Prompt recognition and timely surgical intervention are critical for favorable outcomes and uterine preservation.