Ruptured Subserosal Pyomyoma Presenting as Peritonitis in the Early Postpartum Period: A Case Report.

Introduction: Uterine leiomyomas (fibroids) are common benign tumors in women of reproductive age. Pyomyoma (suppurative leiomyoma) is a rare life-threatening complication arising from infarction and secondary infection of a fibroid, most often occurring during pregnancy or the postpartum period. Diagnosis is challenging due to nonspecific presentations. Case Presentation: We report a 24-year-old primiparous woman (G1P1) who presented on postpartum day 9 with acute abdominal pain, fever, and leukocytosis. Imaging (CT) revealed a large subserosal fibroid with intraperitoneal free fluid and pockets of gas. Management and Outcome: The patient underwent emergent exploratory laparotomy. A 10×15 cm perforated, purulent pedunculated subserosal leiomyoma with surrounding adhesions was identified, and postpartum abdominal hysterectomy was performed for source control. Postoperative broad-spectrum antibiotics were administered. The patient improved rapidly, with normalization of white blood cell count and resolution of symptoms, and was discharged home in good condition. Conclusion: This case highlights the need for high suspicion for pyomyoma in postpartum patients with fibroids who develop severe abdominal pain and sepsis. Prompt imaging and surgical intervention are critical to avoid morbidity and mortality from this rare complication.