Intraoperative diagnosis of a giant pedunculated uterine myoma mimicking an adnexal mass presenting with acute abdomen in a resource-limited setting

Uterine myomas are common benign tumors of the female reproductive tract and are typically diagnosed in women of later reproductive age. Presentation as an acute abdomen due to a giant pedunculated subserosa myoma is uncommon, particularly in very young women. Such cases may closely resemble adnexal pathology and lead to diagnostic uncertainty, especially in resource-limited settings where access to imaging is restricted. Reporting this case highlights an unusual clinical presentation and important diagnostic challenges, particularly in a resource-limited setting. A 21-year-old woman from sub-Saharan Africa with a history of primary infertility and menometrorrhagia presented with sudden-onset severe lower abdominal pain associated with a tender pelvic mass. She was managed as a case of acute abdomen. Due to the unavailability of ultrasonography, an emergency exploratory laparotomy was performed. Intraoperatively, a giant pedunculated subserosa uterine myoma was identified, with both ovaries and fallopian tubes appearing normal. A fertility-preserving myomectomy was successfully performed. Histopathological examination could not be performed, because histopathology services were unavailable. The postoperative course was uneventful, and the patient was discharged in good clinical condition on the fifth postoperative day. Giant pedunculated uterine myomas should be considered in the differential diagnosis of acute abdomen in women of reproductive age, including young patients. In resource-limited settings, prompt diagnosis and management may rely heavily on careful clinical assessment and timely surgical intervention, particularly in emergency situations.