Second trimester semi-elective abdominal myomectomy to manage severe systemic inflammatory response syndrome secondary to fibroid degeneration

Although leiomyomata are common, it is rare for them to be associated with severe complications in pregnancy. We describe the case of a primigravida with a known multifibroid uterus. She presented at 16 weeks’ gestation with abdominal pain, distension, raised serum inflammatory markers and features of a gastrointestinal ileus. The patient was initially managed conservatively; however, her clinical condition deteriorated and she developed a severe systemic inflammatory response syndrome (SIRS). Imaging demonstrated red degeneration of two large leiomyomata, small bowel obstruction and ascites. Following a multidisciplinary team meeting, the patient was offered an antenatal abdominal myomectomy, or a termination of pregnancy plus deferred elective myomectomy. She underwent a successful abdominal myomectomy at 17+4 weeks’ gestation and subsequently had an uncomplicated elective Caesarean section at 39 weeks’ gestation. This report highlights the importance of multidisciplinary team management and informed consent in a surgically complex patient in the second trimester of pregnancy.