Background: Uterine leiomyomas have several intermediate histologic variants that are associated with varied clinical presentations. Case: A 26-year-old woman presented with acute onset of left lower quadrant pain after swimming. Radiologic imaging revealed a large pelvic mass attached to the uterus. Exploratory laparotomy revealed a pedunculated uterine mass and hemoperitoneum caused by an avulsed adhesion between the left broad ligament and the mass. Histopathologic evaluation of the excised mass was consistent with a symplastic leiomyoma. Results: The patient was discharged on postoperative day 2 with a hemoglobin level of 9.8 g/dL. Postoperative recovery was unremarkable. Conclusions: Symplastic leiomyomas can present with acute peritoneal signs and hemoperitoneum caused by avulsion or rupture. (J GYNECOL SURG 28:355)
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