a 56-year - old postmenopausal woman presented to the emergency department with a 2-day history of intermittent , sharp , severe lower abdomen pain , most prominent over right flank . she did not have any positive past medical or surgical history , family history , or allergy history and was not taking any medication . on examination , she had a blood pressure of 151/86 mmhg , heart rate of 115/min , respiratory rate of 18/min , and temperature of 100.1f . abdominal examination revealed normal bowel sounds , firm abdomen , with palpable uterus above umbilicus and tenderness over the right lumbar region without any rebound tenderness . laboratory evaluation revealed white count of 13,500/l with 88% granulocytes ; hemoglobin of 13.6 g / dl ; platelet count of 185,000/l ; and normal glucose , electrolytes , amylase , lipase , renal , and liver functions . urinalysis and chest radiographs were also normal . computed tomography scan of abdomen and pelvis with oral and intravenous contrast ( fig . 1 ) showed enlarged uterus measuring up to 14.1 cm9.7 cm with irregular and lobular contour , containing multiple uterine fibroids . there was 11.4 cm8.2 cm heterogeneous exophytic fibroid with areas of calcifications , non - uniform enhancement with areas of irregular central necrosis , consistent with degenerating fibroid . she was given nothing by mouth and started on intravenous normal saline infusion , hydromorphone , and metoclopramide as needed . computed tomography scan of abdomen and pelvis showing uterine fibroid with areas of degeneration ( note the arrow showing irregular central necrosis ) . approximately 16 hours after patient 's admission , patient started complaining of worsening right upper and lower quadrant abdominal pain and tenderness . right upper quadrant sonogram showed hepatomegaly , hepatic parenchymal echogenicity , and small amount of pericholecystic fluid . patient was evaluated by gynecologists and surgeons , who attributed the condition to fibroid degeneration . her urine and blood culture also turned out to be negative . the subsequent day , at this point , her antibiotics were discontinued and patient was started on oral diet . three months from discharge , patient continues to do well and has decided against surgery . uterine fibroid is estrogen dependent ( 2 ) ; hence , it tends to regress and become clinically insignificant after menopause ( 13 ) . there are rare case reports of postmenopausal hyaline ( 5 ) or cystic degeneration of fibroid ( 4 , 6 ) . these patients , however , presented with mass effects rather than acute abdomen . as illustrated by this case , degenerative changes can occur in fibroids after menopause and can present as acute abdomen , low grade fever , and leukocytosis , masquerading surgical abdomen . other degenerations include myxomatous changes ( 13% ) , calcification ( 8% ) , mucoid changes ( 6% ) , cystic degeneration ( 4% ) , red degeneration ( 3% ) , and fatty changes ( 3% ) ( 7 ) . degenerative changes are considered to result from excessive growth that outmatches the blood supply , or mechanical compression of the feeder arteries . the increase in the size of fibroid as a result of hyaline or cystic degeneration is presumed to result from accumulation of extracellular matrix ( 5 ) . although the precise pathogenesis for degeneration of fibroids in postmenopausal women remains unclear , excessive production of growth factors ( epidermal or insulin - like ) from the fibroid might explain this condition . such malignant transformation occurs in middle aged to older women and should be considered in postmenopausal women with rapid enlargement of the fibroid ( 8) . in this patient , however , lack of further symptoms at 3-month follow - up is highly against such a possibility , given the aggressive nature of uterine leiomyosarcoma . fibroid degeneration can occur after menopause.acute abdominal pain , low grade fever , and leukocytosis can be the presenting feature , thus masquerading surgical acute abdomen . 
  fibroid degeneration can occur after menopause . acute abdominal pain , low grade fever , and leukocytosis can be the presenting feature , thus masquerading surgical acute abdomen . fibroid degeneration can occur after menopause.acute abdominal pain , low grade fever , and leukocytosis can be the presenting feature , thus masquerading surgical acute abdomen . 
  fibroid degeneration can occur after menopause . acute abdominal pain , low grade fever , and leukocytosis can be the presenting feature , thus masquerading surgical acute abdomen . the authors have not received any funding or benefits from industry or elsewhere to conduct this study .
uterine fibroid , one of the most common tumors in women , is estrogen dependent , which commonly regresses after menopause . 
 fibroid degeneration after menopause , therefore , is rare . here 
 the authors report a case of 56-year - old postmenopausal woman who presented with acute abdominal pain , low grade fever , and leukocytosis as a result of fibroid degeneration .