Nonobstructive Acute Renal Failure with a Large Solitary Fibroid (original) (raw)
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Renal impairment as a complication of uterine fibroids: A retrospective hospital-based study
Journal of Obstetrics & Gynaecology, 2013
We reviewed female patients with the diagnosis of renal impairment managed at the University Hospital of the West Indies over a 5-year period (Leiomyomas can cause obstructive renal impairment and renal failure. This was a retrospective study of women with renal impairment seen at the University of the West Indies Hospital, Jamaica, between 2000 and 2004, looking at aetiology and severity (group 1). We also evaluated patients, in the same hospital, with fi broids who had ultrasonography during a later period (2006 -2011), comparing those who had hydronephrosis and those without (group 2). In group 1, 274 women were coded as renal impairment. Case notes for 160 patients (59%) were analysed. Uterine fi broids accounted for 13/160 (8.1%) of cases. Comparing cases with and without fi broids, none of those with fi broids were over 50 years old compared with 59.3% of the others, OR 0.02 (CI 0.00 -0.35) p ؍ 0.0001. Hospital data for renal failure showed that most mean values were signifi cantly better for those with fi broids. Urea, 8.59 mmol/l (SD 9.89) vs 17.00 mmol/l (SD 13.41) p ؍ 0.003; Creatinine 300.15 μ mol/l (SD490.92) vs 424.05 μ mol/l (SD553.29) p ؍ 0.022 and Creatinine clearance 73.21 ml/min (SD 38.92) vs 44.25 ml/min (SD 49.71) p ؍ 0.017. However, mean potassium values were similar, 4.52 mmol/l (SD 0.61) vs 4.85 mmol/l (SD1.03) p ؍ 0.2.
Acute Cardiovascular Collapse Secondary to Massive Hemoperitoneum from a Bleeding Uterine Fibroid
Journal of Gynecologic Surgery, 2012
Background: This case report illustrates that spontaneous vascular rupture in a fibroid can cause acute cardiovascular collapse, and that this should be borne in mind in the differential diagnosis of acute abdomen, especially in the presence of an abdomino-pelvic mass. Case: A 41-year-old nullipara presented in the Casualty Department at Obafemi Awolowo University Teaching Hospitals Complex with a 5-hour history of severe abdominal pain, dizziness, and fainting attack. She was in hypovolemic shock with generalized peritonitis. After resuscitative measures, an emergency exploratory laparotomy was performed. It revealed a ruptured big blood vessel at the top of a 30-week-sized uterine fibroid and 2 L of hemoperitoneum. The vessel was ligated, and 2 units of blood were transfused intra-operatively. The patient had an emergency myomectomy. Results: Her postoperative recovery was uneventful. Conclusions: Sudden rupture of a vascular supply to a uterine fibroid can mimic acute ruptured ectopic pregnancy. (J GYNECOL SURG 28:40
Surgical challenges in fibroid uterus - case series
The New Indian Journal of OBGYN
Background: It is an art and skill to surgically remove large and difficult fibroid & hysterectomies. This case series mentions variety of fibroids at different ages including pregnancy & numerous ways of surgically handling them successfully. Objectives: To study various surgical challenges and ways to overcome them in fibroids. Method: Total 10 cases with challenging surgeries were studied at Govt Medical College Hospital, Aurangabad from May 2018 to May 2019. Demographic details, presenting complaints, clinical examination findings, imaging techniques, investigations and operative difficulties and measures to prevent complications were studied. Results: Some presurgical techniques like preoperative use of GNRH analogue, preoperative stenting of ureter, anaemia correction and intraoperative techniques like hemi section of uterus, enucleating the fibroid using correct surgical plane, identifying ureter and surgical expertise helped to avoid all complications in surgery. Conclusions: Knowledge of altered anatomical structures, meticulous surgery by an expert following all surgical principles in fibroid surgery prevent injuries to the urinary tract, reduce blood loss and make surgery successful.
Objective cure of urinary retention following laparoscopic hysterectomy for a large uterine fibroid
International Urogynecology Journal, 2010
Acute urinary retention (AUR) in women is not uncommon. Many reports have been published discussing the possible theories and pathogeneses of this condition. AUR induced by uterine fibroid is a rare entity that has been mentioned only in case reports. All the reported cases focused mainly on the different approaches for fibroid management. In this study, we present a 52-year-old female with recurrent episodes of urinary retention that was related to periods of menstruation. Pelvic magnetic resonance imaging revealed a markedly enlarged uterus with multiple fibroids. The patient had laparoscopic hysterectomy with postoperative resolution of patient's symptoms and improved uroflow studies. This is the first article that proves the cure of AUR following hysterectomy using an objective tool.
Ultrasonographic characterisation of obstructive uropathy in Nigerian women with uterine fibroids
Objectives: The objective of this study was to determine the prevalence of upper renal tract obstructive changes in women with uterine fibroids using ultrasonography (USG). Methods: We enrolled 140 women with uterine fibroids and performed USG of the uterus and upper renal tract with full and empty urinary bladders, respectively. The number of fibroid nodules and the uterine volume were determined. The presence of hydronephrosis was graded and documented. Uterine volumes >200 cm3 were denoted as large and vice versa. Statistical analysis was done using Chi-square and non-parametric tests. Results: The median uterine volume was 556 cm3. Application of a 200 cm3 cut-off value yielded 126 (90%) large uterine volumes and 14 (10%) small uterine volumes. Of the 140 women enrolled, 52 (37.1%) had renal backpressure changes. Of these 52 patients, 51 (98.1%) had uterine volumes >200 cm3. Both kidneys were affected in the vast majority (36 out of 52 = 69.2%) of those with renal backpressure changes, and 23 (44.2%) of the 52 women with renal backpressure changes had mild (Grade 1) hydronephrosis, while 25 (48.1%) had moderate (Grade 2) hydronephrosis. When unilateral, however, backpressure changes were signifcantly more common on the right side. Conclusion: Approximately one in three women with fbroids had renal backpressure changes in this study. Large uterine volume is a key predisposing factor. Routine sonographic assessment of fibroids should include a focused/targeted evaluation of the kidneys.
Uterine Fibroid Embolization for Patients with Acute Urinary Retention
Journal of Vascular and Interventional Radiology, 2008
Acute urinary retention due to uterine fibroids is rare. In reported cases, hysterectomy and myomectomy have been the recommended therapies. Herein, the authors describe two patients with acute obstructive urinary retention who experienced immediate improvement and the ability to spontaneously void after uterine fibroid embolization. The rapidity of response and the nonsurgical nature of this therapy suggest that it may be used as the first-line therapy for this rare event.
Successful pregnancy following myomectomy for giant uterine fibroid in an infertile woman
Journal of reproduction & infertility, 2014
Giant uterine fibroid is a rare tumor of the uterus, usually symptomatic requiring surgical intervention. Uterine fibroid is generally common among black women. In this study, a case of 31 year old nullipara was reported who presented to the Gynaecology unit of Enugu State University Teaching Hospital (ESUTH), Nigeria with a history of progressive abdominal swelling of 8 years duration, six years duration of infertility and weight loss and dyspnoea on exertion. Physical examination and transabdominal ultrasound revealed a huge abdominopelvic mass. She had myomectomy. She had a histologically confirmed giant uterine fibroid that weighed 16.8 kg. She subsequently achieved a live birth. Giant uterine fibroids are relatively rare. It poses great challenges in its management. The surgical option of management should consider the fertility preservation and aspiration of couples especially in developing countries.
2021
The case is that of a 40 year old nulliparous who presented with progressive abdominal swelling, bilateral leg swelling, easy fullness and weight loss. She was married but husband had abandoned her because of this problem. Abdomen was massively distended without clinical signs of ascites. Ultrasound scan revealed abdominopelvic mass with features of uterine fibroid with pressure effects on the urinary tract. She had myomectomy done at which an unusually massive uterine fibroid in adhesions with anterior abdominal wall and the liver was found. She had prolonged daily peritoneal fluid effluent in excess of 300 mls for about 2 weeks which was managed. Histology of specimen revealed uterine leiomyoma. Late presentation for uterine fibroid is common in this part of the world, however this incident case that weighted 15 kg and involved in adhesion with the liver is not common. It is adviseable for patients with uterine fibroid to present early for treatment to achieve better outcome. It i...
A Rare Cause for Red Degeneration of Fibroid Uterus
Journal of Gynecologic Surgery, 2010
Background: Red degeneration of fibroid is a rare event, but when it occurs, it is reported more often during pregnancy as an acute clinical presentation. Its occurrence is even rare in nonpregnant woman. On gross appearance, it resembles leiomyosarcoma, a malignant neoplasm of uterine smooth muscle. Differentiation is important in the therapeutic point of view, which can be certain only by histopathologic examination. Case: A 37-year-old multiparous lady presented with severe anemia and pain in the abdomen, and a mass abdomen of 3 months' duration was found to have a fibroid uterus of 20Â12 cm in size, which was confirmed by transabdominal ultrasonogram. The cause of her anemia was found to be infestation with hookworm (ankylostoma duodenale). She was treated with antihelminthics and blood transfusion before laparotomy. At laparotomy, a pedunculated subserous fibroid of 20Â15 cm was found to be attached to the fundus of the uterus by a thin, short, necrotic pedicle. It was excised, and the cut section showed an hemorrhagic fleshy mass, which could not be differentiated from a leiomyosarcoma. Histopathologic examination revealed red degeneration. Conclusions: This case was reported because of the rare occurrence of red degeneration in a nonpregnant woman, chronic presentation, and its gross resemblance to that of leiomyosarcoma.