Disseminated peritoneal leiomyomatosis (DPL) is a rare and benign condition characterized by the progression of smooth muscle tumors across the peritoneal cavity. The etiology is not well understood and could include previous surgeries and hormonal stimulation. We report on a 39-year-old woman with extensive DPL at the end of her pregnancy. She was diagnosed in the context of amenorrhea and was initially treated by gonadotropin-releasing hormone (GnRH) agonist. During pregnancy, a significant increase in lesion size was observed. The day before the planned cesarean-section (C-section), she presented with severe hypercalcemia, which was probably from a paraneoplastic origin. The patient underwent a planned C-section at 36 weeks and 5 days of gestation by midline sub-umbilical laparotomy, allowing a safe delivery.

This case provides insights for healthcare providers facing similar cases, considering that the obstetrical management of patients with DPL has not yet been defined.