A Giant Pedunculated Uterine Myoma Mimicking an Adnexal Mass Presenting with Acute Abdomen in a 21-Year-Old Woman with Infertility, Diagnosed Intraoperatively: a case report

Background Uterine myomas are common benign tumors of the female reproductive tract; however, an acute abdomen caused by a giant pedunculated subserosa myoma is rare, particularly in young women. Such cases may mimic adnexal pathology and pose significant diagnostic challenges, especially in resource-limited settings. Case Presentation A 21-year-old female from sub-Saharan Africa with primary infertility and menometrorrhagia came to the hospital with sudden lower abdominal pain and a tender pelvic mass. She was treated as a case of acute abdomen. Since ultrasonography was not available, an emergency laparotomy was done, which found a large pedunculated subserosa uterine myoma and normal adnexa. A fertility-preserving myomectomy was performed, and she was discharged in good condition on the fifth day after surgery. Conclusion When evaluating women of reproductive age, including younger patients, for an acute abdomen, consider giant pedunculated uterine myomas as a possible cause. In resource-limited settings, timely diagnosis and management may rely primarily on thorough clinical evaluation, particularly in emergencies.