Giant parasitic leiomyoma: A rare cause of acute appendicitis and bowel injury

Parasitic fibroids are an uncommon subtype of leiomyomas that can implant on peritoneal surfaces such as the omentum or bowel serosa and may mimic malignancy on imaging. While typically asymptomatic, they can occasionally present with acute abdominal complications. We describe the case of a 37-year-old woman who presented with abdominal pain and a palpable mass. Imaging revealed a large, heterogeneously enhancing lesion with central necrosis, raising concern for malignancy. Surgical exploration identified a 17.5 × 15 cm parasitic leiomyoma adherent to the bowel and appendix, resulting in acute appendicitis and bowel injury, both of which required surgical management. Histopathological analysis confirmed a benign leiomyoma with myxoid degeneration and acute suppurative appendicitis. This case highlights the importance of considering parasitic fibroids in the differential diagnosis of abdominopelvic masses and acute abdomen, particularly in women with a history of pelvic surgery. Given their potential to mimic malignancy and cause secondary inflammatory complications, close collaboration between radiologists and surgeons is essential for accurate diagnosis and effective treatment.