Abstract
Background: Uterine leiomyomas are the most typical benign pelvic neoplasms in women. Giant leiomyomas are very rare and present diagnostic and management challenges.
 Case presentation: A 50-year-old presented to the gynecology clinic with abdominal distension associated with mild lower abdominal pain, which had progressively worsened for five years. She reported no history of vaginal discharge or abnormal uterine bleeding. On examination, she had a grossly distended abdomen with a firm, nontender pelvic mass extending to the xiphisternum. An ultrasound scan revealed a giant leiomyoma. She underwent a multidisciplinary total abdominal hysterectomy, which was complicated by a bladder injury. She recovered well postoperatively with a resolution of her symptoms.
 Conclusion: Surgery for giant uterine leiomyomas can be challenging and requires careful surgical preparation with appropriate imaging and uterine artery embolization where available. Anticipation of complications and multidisciplinary team management are critical.
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