Pedunculated uterine leiomyoma clinically and ultrasonographically simulating an incarcerated spigelian hernia at 32 weeks' gestation: Report of a case

We report an unusual case in which a woman presented to Labor and Delivery at 32 weeks' gestation due to increasing anterior lower abdominal pain in association with an intermittently-appearing mass, which had previously been reducible. On physical examination, a tender 5-cm mass protruding from the lower abdominal wall was considered separate from the uterus. Anatomically and by ultrasonographic examination, the mass was considered consistent with an incarcerated Spigelian hernia, possibly containing bowel, although a pedunculated degenerating uterine leiomyoma could not be ruled out with certainty. Following surgery consultation and before a definitive computed tomography could be performed, the patient delivered spontaneously. During the immediate postpartum period, the mass receded from the anterior abdominal wall. Bimanual examination following the third stage of labor had delineated a 5-cm mass closely related to the anterior aspect of the uterus, strongly suggesting the presence of a pedunculated uterine leiomyoma.