Parasitic leiomyoma causing small bowel perforation
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Parasitic leiomyomas are rare extra-uterine smooth muscle neoplasms. Originally described by Kelly and Colon in 1909, they were thought to originate from subserosal myomas that twisted off their uterine pedicle and survived via neovascularization of adjacent organs. More recently, parasitic leiomyomas have been found after myomectomies or morcellation of leiomyomas, though the true pathophysiology is still unclear. Few cases have been documented of parasitic leiomyomas attaching to the small bowel, omentum, and pelvic sidewall causing a small bowel obstruction (SBO). A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. This case demonstrates that parasitic leiomyomas can cause not just obstruction but also outright perforation of the bowel.