BACKGROUND: The Meigs' syndrome is a rare but well-known syndrome defined as the 
triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' 
syndrome always requires surgical treatment. However, the optimal approach for 
its management has not been sufficiently investigated.
CASE PRESENTATION: We report a patient with a large twisted ovarian fibroma 
associated with Meigs' syndrome, abdominal pain and severe hemolytic anemia that 
was treated by laparoscopic surgery. This case highlights the difficulties that 
may be encountered in the management of patients with Meigs' syndrome, including 
potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may 
influence the medical and surgical approach and the adverse impact that Meigs' 
syndrome can have on the patient's condition, especially if it is associated 
with acute pain and severe anemia. Considering the patient's serious clinical 
condition and assuming that she had Meigs' syndrome with a twisted large ovarian 
mass and possible hemolytic anemia, we first concentrated on effective medical 
management of our patient and chose the most appropriate surgical treatment 
after laparoscopic examination. The main aim of our initial approach was 
preoperative management of the anemia. Blood transfusions and glucocorticoid 
therapy resulted in stabilization of the hemoglobin level and normalization of 
the bilirubin levels, which confirmed the appropriateness of this approach. 
Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the 
tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in 
timely resolution of symptoms, short hospitalization, relatively low morbidity 
and a rapid return to her social and professional life.
CONCLUSIONS: This case highlights the difficulties that may be encountered in 
the management of patients with Meigs' syndrome, including potential 
misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the 
medical and surgical approach, and the adverse impact that Meigs' syndrome can 
have on the patient's condition, especially if it is associated with acute pain 
and severe anemia. The present case suggests that laparoscopic surgery for 
potentially large malignant tumors is feasible and safe, but requires an 
appropriate medical and gynecological oncology expertise.