A Challenging case of Broad ligament fibroid

ABSTRACT: Leiomyomas are the most common benign tumours of female reproductive system which occur in women of child- bearing ages. Large fibroids are known to arise from uterus, but rarely from broad ligament. Broad ligament fibroids are rare extrauterine leiomyomas that arise within the folds of the broad ligament, often displacing the uterus and mimicking adnexal masses. Their location poses diagnostic challenges and can complicate surgical management. We report the case of a 37-year-old female, para 2 living 2, with a history of two previous lower segment cesarean sections and post-tubectomy status, who presented with complaints of lower abdominal pain radiating to the back and left flank. On clinical examination, the patient was vitally stable. Bimanual pelvic examination revealed an anteverted uterus corresponding to approximately 14 weeks’ gestational size. Bilateral fornices were free, with no cervical motion tenderness, and no separately palpable adnexal mass. Transvaginal sonography (TVS) showed two well-defined solid masses arising from the bilateral broad ligaments, displacing the uterus centrally, and maintaining a clear plane from the uterine wall findings suggestive of bilateral broad ligament fibroids. Given the patient’s completed family and persistent symptoms, a decision was made to proceed with total abdominal hysterectomy with bilateral salpingectomy (TAH with BS). Intraoperatively, two large fibroids were noted arising from the left and right broad ligaments, with the uterus displaced superiorly. Contrary to preoperative expectations, no adhesions were noted, and the surrounding pelvic anatomy was preserved. The procedure was carried out without complications, and estimated blood loss was minimal. Postoperative recovery was uneventful. Histopathological examination confirmed bilateral benign leiomyomas along with normal endometrium and fallopian tubes. This case highlights the rare presentation of bilateral broad ligament fibroids and reinforces the importance of thorough preoperative imaging, clinical correlation, and individualized surgical planning. TAH with BS is a definitive and effective treatment in symptomatic women with completed families, offering excellent outcomes even in anatomically complex fibroid locations. Keywords: Broad ligament fibroid, Bilateral fibroids, Extrauterine leiomyoma, Transvaginal sonography, Total abdominal hysterectomy, Pelvic mass, Uterine fibroids, Gynecologic surgery