Intestinal Obstruction Secondary to Necrotic Subserosal Uterine Fibroids: A Case Report of a Rare Surgical Emergency in a Young Woman

Abstract Background Uterine fibroids or leiomyomas are the most common benign gynecologic neoplasms in women of reproductive age. They usually have no symptoms, but on the basis of quantity, size, or site, these tumours may cause a variety of symptoms. Where it happens very rarely with severe complications like necrosis and intra-abdominal infection, it becomes a matter of great importance with regard to a patient with intestinal obstruction complicating uterine fibroids. Here, we report a case where a young female had developed acute small bowel obstruction due to large, necrotic subserosal uterine fibroids. Case Presentation A 30-year-old woman was admitted to the periphery with a history of severe abdominal pain over the last two days she also noted progressive abdominal distention, dyspnea, vomiting, and more importantly no passage of stools and an increase in urinary frequency. During admission, she was tachycardic with a pulse rate of more than 125 beats per minute. Abdominal examination was notable for distension, with a solid, irregular, suprapubic mass in keeping with a symphysiofundal height of 34 cm, with tympanitic percussion notes, hyperactive bowel sounds. Her abdominopelvic sonography revealed a large uterine mass of 16 cm × 17 cm in size. Subsequently, her condition deteriorated to peritonitis, marked by generalized abdominal tenderness, defensive guarding, rigidity, and absent bowel sounds accompanied by desaturation; on room air her saturation varied from 89% to 94%. Prompt exploratory laparotomy was performed, and intraoperative findings revealed three fibroids of subserosal origin, the largest fibroid was necrotic, measuring 24 cm × 16 cm and weight was 2.6 kg, in addition to a tight adhesive tissue alongside adhesions of various intestines loop. There was found to be approx. 2 liters of free pus in the abdominal cavity, and consequently, small bowel obstruction was confirmed. Myomectomy was performed successfully. She made an uneventful recovery in the postoperative period and was discharged one week later. Conclusion This case underscores that intestinal obstruction, though a rare complication of uterine fibroids, can present as a surgical emergency, particularly when necrosis and infection supervene. In women of reproductive age presenting with acute abdominal symptoms, a high index of suspicion for gynecological pathology, including fibroids; is essential for timely diagnosis and surgical intervention to prevent significant morbidity.