Intestinal Obstruction Secondary to Necrotic Subserosal Uterine Fibroids: A Case Report of a Rare Surgical Emergency in a Young Woman

In the human body, the uterus is a muscular organ that can sometimes develop benign growths known as fibroids. These are not cancerous tumors but rather clumps of smooth muscle and fibrous tissue that form within or on the wall of the uterus. While many women carry these growths without ever knowing it, the size, number, and location of a fibroid can determine whether it causes trouble. When a fibroid grows large enough, it can press against nearby organs like the bladder or the intestines, creating a sense of fullness or pressure. In very rare and severe instances, a fibroid can outgrow its own blood supply, causing the tissue inside to die, a process called necrosis. This dead tissue can become a breeding ground for infection, leading to a dangerous buildup of pus inside the abdomen. When this happens, the body's natural response is to create scar-like bands of tissue, known as adhesions, which can stick organs together. If these bands become tight enough, they can trap a loop of the intestine, blocking the passage of food and waste. This specific chain of events, where a dying fibroid causes an intestinal blockage, is so uncommon that it often catches doctors off guard, turning a routine abdominal complaint into a life-threatening emergency.

This story begins with a thirty-year-old woman who arrived at a health facility in Ghana suffering from severe abdominal pain that had been worsening over two days. She was in significant distress, unable to pass stool, vomiting, and struggling to breathe. When doctors examined her, they found her heart racing at more than 125 beats per minute and her abdomen swollen and hard. A simple ultrasound scan revealed a massive mass inside her uterus, measuring 16 by 17 centimeters. However, the situation quickly became critical. Her condition deteriorated rapidly, and she developed signs of peritonitis, a severe inflammation of the abdominal lining characterized by extreme tenderness, a rigid stomach wall, and a complete stop in bowel sounds. Her oxygen levels also began to drop, fluctuating between 89 and 94 percent while she breathed room air. Because the facility did not have access to advanced imaging like a CT scan, the medical team relied on their clinical judgment and the urgency of her symptoms to make a decision. They determined that she needed immediate surgery to explore her abdomen and find the source of the blockage.

When the surgeons opened her abdomen, they discovered a complex and dangerous situation. Inside the cavity, there were three fibroids growing on the outer surface of the uterus. The largest of these was the culprit; it had grown to an enormous size of 24 by 16 centimeters and weighed 2.6 kilograms. This massive growth had died, turning necrotic, and had become the center of a severe infection. The surgeons found approximately two liters of thick, foul-smelling pus filling the abdominal cavity, a clear sign that the body was fighting a massive battle against infection. The necrotic fibroid had not just sat there; it had triggered the formation of dense, thick bands of scar tissue that had firmly glued the fibroid to several loops of the small intestine. These adhesions had pulled and twisted the intestines, creating a tight knot that completely blocked the passage of contents through the bowel. The blockage was so severe that it had caused the intestine to swell with gas and fluid, leading to the dangerous symptoms the woman had experienced.

The surgical team performed a myomectomy, a procedure to remove the fibroids, to clear the obstruction and stop the infection. They carefully cut away the adhesions and removed the three fibroids, including the massive, necrotic one. Once the blockage was cleared and the source of the infection was gone, the surgeons cleaned out the two liters of pus from her abdominal cavity. The woman was then moved to intensive care, where she was kept without food or drink to let her intestines rest, while receiving fluids, antibiotics to fight the infection, and medication to prevent blood clots. Her recovery was smooth and uneventful. She did not suffer any further complications from the surgery and was well enough to leave the hospital just one week after the operation. She was scheduled for follow-up visits to ensure she remained healthy, but the immediate crisis had been resolved.

This case highlights a rare but critical lesson for medical professionals, particularly in settings where advanced diagnostic tools are not always available. While intestinal blockages are usually caused by scar tissue from previous surgeries, this instance showed that a dying uterine fibroid can also be the cause. The necrosis of the fibroid created a perfect environment for bacteria to thrive, leading to an infection that caused the intestines to stick together and stop working. The authors of this report emphasize that when a woman of reproductive age comes in with sudden, severe abdominal pain and signs of a blockage, doctors must consider gynecological problems as a possible cause, not just digestive ones. By keeping a high level of suspicion for conditions like fibroids, especially when they might be dying or infected, medical teams can make faster decisions and perform the necessary surgery before the situation becomes fatal. This single case serves as a reminder that even rare complications can present as urgent emergencies, and that a careful look at the whole picture is essential for saving a life.