Leiomyoma are the most common benign tumors of the uterus, present in almost 30% of all women in the reproductive age group. The commonest site being the uterus. Extra-uterine leiomyoma is rare to come by with cervical fibroids accounting for 1-2 % and broad ligament accounting for less than 1 % of cases. Pre-operatively, it poses a great challenge to diagnose broad ligament fibroids, as it is difficult to differentiate between an adnexal or uterine pathology. Here, we report a case of a rapidly growing broad ligament fibroid and illustrate the importance of accurate pre-operative diagnosis and the surgical challenge in removing the fibroid while preserving the uterus and vital organs.

A 28-year-old, Para 1 with secondary subfertility for 9 years presented to us with complaints of severe dysmenorrhea and a mass per abdomen for 1-month duration. There was a pelvic mass of 18 weeks’ size, which was mobile and able to get below.  Ultrasound showed a uterus measuring 8 x 4.5 cm with a right solid adnexal mass measuring 10 x 8.5 cm. However, within 2 months the mass grew to 28 weeks’ size with restricted mobility. This prompted for a CT scan in view of the nature and rapid enlargement of the mass. CT scan reported a huge heterogeneously enhancing pelvic mass likely ovarian in origin, measuring 20.4 x 9.6 x 27.8 cm. However, a differential diagnosis of a broad ligament fibroid was made based on clinical and radiological findings. An Exploratory laparotomy was performed, which revealed a huge solid multi-lobulated right broad ligament leiomyoma arising from the broad ligament distorting the whole pelvic anatomy. The challenge was to remove the mass without injuring the uterus, bladder and the ureter while preserving the blood supply to the ovary, fallopian tube and uterus. After 2 hours of careful meticulous dissection, the mass was removed as a whole and the uterus was preserved. She had an uneventful recovery.

Diagnosing and mmanaging a broad ligament fibroid is always a challenge. It may present as a mass per abdomen with pressure symptoms, menstrual irregularities or fertility issues.  Ultrasound and CT scan may be helpful in shedding a clue to the diagnosis but is not diagnostic. Surgery is technically challenging due to its close proximity to the ureters and vascular blood supply to the uterus and ovary. Hence, meticulous dissection is required to prevent morbidity and complications.