Non-traumatic avulsion of a leiomyoma

A patient in her 30s was referred to our Gynaecology Outpatient Department due to symptomatic leiomyoma which was first identified during her first pregnancy. An MRI performed postnatally confirmed a 10.5 cm leiomyoma. The patient was experiencing heavy menstrual bleeding and intermittent pelvic pain presumed to be secondary to a pressure effect. Treatment options were discussed, and it was decided to proceed with open myomectomy. On entry to the abdomen, the leiomyoma was free floating with no uterine attachment and only held loosely to the dome of the bladder, sigmoid colon and the left fallopian tube by filmy adhesions.