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Background Parasitic leiomyomas are rare extra-uterine tumors that can be seen in patients after myomectomy or morcellation of leiomyomas. Case A 63-year-old woman with a history of abdominal myomectomy 20 years prior presented with worsening abdominal distension and pain for the past eight months. The patient delayed care due to fear of the COVID-19 pandemic and was found to have a 42 cm parasitic leiomyoma attached to the small bowel causing obstruction and perforation. Conclusion Parasitic leiomyomas can cause small bowel obstruction and perforation., Highlights • Parasitic leiomyomas can range in presentation from asymptomatic to sepsis. • Parasitic leiomyomas can cause small bowel obstruction and perforation. • Care should not be delayed in the setting of the COVID-19 pandemic.