Management of atypical complicated abdominal masses in the second trimester of pregnancy

A nulliparous woman in her 40s presented with abdominal pain and dyspnoea during the second trimester of pregnancy. Ultrasonography revealed two large abdominal masses: the upper lesion occupied the entire left subphrenic space extending to the uterine fundus, whereas the lower lesion filled the pouch of Douglas. The patient underwent laparotomy, with the caudal mass left in situ within the pelvis. She subsequently had a regular obstetric follow-up and an elective caesarean delivery, resulting in an excellent maternal and neonatal outcome. In cases of large symptomatic masses during pregnancy, comprehensive evaluation using bimanual examination and safe imaging modalities, such as ultrasound and non-contrast MRI, is essential. Surgical management should be considered only in the presence of oncological suspicion or clinical complications, always aiming to preserve pregnancy and avoid overtreatment. The mode of delivery should depend on the size, number and anatomical location of uterine masses.