CASE REPORT Open Access Diagnostic ambiguity of aseptic necrobiosis of a uterine fibroid in a term pregnancy: a case report Julius Sama Dohbit 1,2 , Esther Ngo Um Meka 1,2 , Joel Noutakdie Tochie 3* , Igor Kamla 3 , Celestin Danwang 3 , Frank-Leonel Tianyi 4 , Pascal Foumane 1,2 and Gervais Ondobo Andze 3,5 Abstract Background: Uterine fibroids are the most common uterine tumours in females of reproductive age. During pregnancy, uterine fibroids may be complicated by aseptic necrobiosis. We herein report an ambiguous clinical presentation of uterine fibroids in pregnancy and discuss the diagnostic challenges encountered in our resource- constraint setting. Case presentation: A term pregnant Cameroonian woman was admitted to our maternity unit with clinical findings suggestive of a strangulated umbilical hernia. She underwent an emergency caesarean section which fortuitously revealed aseptic necrobiosis of a uterine fibroid, managed within the same surgical intervention by myomectomy. Her post-operative course was uneventful. Conclusion: The authors highlight the need for a high index of suspicion by healthcare providers, as well as the need for a multidisciplinary approach for a favourable maternal and foetal outcome. Keywords: Uterine fibroid, Leiomyoma, Pregnancy, Aseptic necrobiosis, Red degeneration Background Leiomyomas (uterine fibroids) are the most common be- nign tumors of the uterus [1]. They are very common, affecting 40% of women of reproductive age and their frequency increases with age, from a prevalence of 50% at age 35 years, to 80% at age 50 years [1]. An increase in the age of first pregnancy from 24 years in 1978 to 30 years in 2012 has seen an increase in the occurrence of uterine fibroids in pregnancy [2, 3]. Pregnant women with uterine fibroids are at an increased risk for compli- cations such as; miscarriages, preterm labour, malpresenta- tion, labor dystocia, cesarean sections and postpartum haemorrhage [4, 5]. Uterine fibroids often increase in size during pregnancy, this increases their risk for complications such as ‘red degeneration’ or aseptic necrobiosis [5] and leads to frequent diagnostic ambiguity of obstetrical or gy- naecological pathologies in resource-challenge settings [6]. Herein, we report the case of an aseptic necrobiosis of a uterine fibroid mimicking a strangulated umbilical hernia on a term pregnancy. Case presentation A 35-year-old G 2 P 0010 Cameroonian student at 39-weeks pregnancy was referred to the surgical unit of the Yaounde Gynaeco-Obstetrics and Paediatric Hospital for the management of a strangulated umbilical hernia. She had a sudden onset of localized umbilical pain three hours prior to consultation. The pain was of moderate intensity, crampy in character, aggravated by walking, without any change in bowel movement and no vomit- ing. An abdominal ultrasound scan revealed a parietal defect of the umbilicus measuring 55 mm in diameter with a poorly vascularised hypoechoic mass (doppler scan) measuring 50 × 30 × 37 mm, 29.6 ml in volume. In addition, the foetus was viable with a normal biophysical score and a good concordance between clinical and sonographic dating of gestational age. Hence, she was * Correspondence: joeltochie@gmail.com 3 Departement of Surgery and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Dohbit et al. BMC Pregnancy and Childbirth (2019) 19:9 https://doi.org/10.1186/s12884-018-2154-x