Giant uterine fibroid complicated by aseptic necrobiosis and cutaneous fistulation: A case report and brief review of literature

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Figure 3. A 30-cm intramural posterior uterine fibroid in necrobiosis.
Published Mar 2, 2025
https://doi.org/10.62438/tunismed.v103i3.5443
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Vol. 103 No. 3 (2025): Tunis Med Mar 2025

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Skander Abid
Department of Obstetric gynecology, Farhat ‎ Hached ‎ University ‎ Hospital of Sousse, ‎ University ‎ of ‎ Sousse, ‎ Faculty ‎ of ‎ Medicine ‎ of ‎ Sousse, Sousse, Tunisia.
Mouna Derouiche
Department of Obstetric gynecology, Farhat ‎ Hached ‎ University ‎ Hospital of Sousse, ‎ University ‎ of ‎ Sousse, ‎ Faculty ‎ of ‎ Medicine ‎ of ‎ Sousse, Sousse, Tunisia.
Ghada Abdelmoula
Department of Obstetric gynecology, Farhat ‎ Hached ‎ University ‎ Hospital of Sousse, ‎ University ‎ of ‎ Sousse, ‎ Faculty ‎ of ‎ Medicine ‎ of ‎ Sousse, Sousse, Tunisia.
Oumayma Ben Rejeb
Department of Obstetric gynecology, Farhat ‎ Hached ‎ University ‎ Hospital of Sousse, ‎ University ‎ of ‎ Sousse, ‎ Faculty ‎ of ‎ Medicine ‎ of ‎ Sousse, Sousse, Tunisia.
Sassi Boughizane
Department of Obstetric gynecology, Farhat ‎ Hached ‎ University ‎ Hospital of Sousse, ‎ University ‎ of ‎ Sousse, ‎ Faculty ‎ of ‎ Medicine ‎ of ‎ Sousse, Sousse, Tunisia.

Abstract

Background: Uterine fibroids are the most common tumors of the female reproductive system. Although often asymptomatic, they can lead to complications such as compression of adjacent organs, torsion, or aseptic necrosis. Cutaneous fistulation, though rare, is a complication presented in this case.


Case presentation: We reported the case of a 41-year-old female with no significant medical history who presented to the emergency department with a 4-month history of pelvic pain and purulent discharge from the supraumbilical region. Physical examination revealed an enlarged abdomen and a 3-cm supra-umbilical parietal mass with fistulation to the skin, discharging pus. Abdominal computed tomography imaging demonstrated a 30-cm uterine fibroid complicated by aseptic necrobiosis and cutaneous fistulation. The patient was started on antibiotic therapy, followed by myomectomy and resection of the fistulous tract by laparotomy.


Conclusion: Cutaneous fistulation of a uterine fibroid is a rare complication that requires prompt detection and an accurate diagnosis for effective management.

Keywords:

Aseptic Necrosis, Case report, Leiomyoma, Myomectomy

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