A 46-year-old woman sought care in our emergency department (ED) for intermittent abdominal pain that she’d had for 3 weeks. The patient had no unusual family history, did not smoke or drink, and had not traveled recently. Over the previous 3 months, she’d experienced dysmenorrhea and menorrhagia during her menstrual cycle. Two days before presenting to our ED, her menstrual cycle began and she complained of persistent lower abdominal pain and hypermenorrhagia.
On physical examination, we noted an enlarged, palpable, fixed, firm mass in the lower abdomen (FIGURE 1A). We also noted considerably decreased bowel sounds on auscultation. A kidney, ureter, and bladder (KUB) x-ray revealed a soft tissue mass shadow in the pelvis (FIGURE 1B).
What is your diagnosis?
How would you treat this patient?