Mrs E.O a 43year old multipara presented to the outpatient department of the Women’s Health and Action Research (WHARC) Abel Guobadia Clinic with the complaints of heavy menstrual bleeding and progressive abdominal swelling of 4 years duration, recurrent painful urination of 3 years duration and right abdominal flank pain of 12 months duration.
Examination revealed the woman was pale and had a mildly elevated blood pressure with grade 2 pretibial edema (swollen legs). There was an abdominal mass corresponding to a 24 weeks pregnant uterus. There was marked suprapubic tenderness and right renal angle tenderness.
Full blood count revealed a packed cell volume of 30 % (all other parameters were essentially normal), serum creatinine was markedly elevated {1.9mg/dl (0.4-0.9mg/dl)}, blood urea nitrogen (10.58mg/d). Renal scan showed a hypo-echoic right kidney with loss of corticomedullary distinction with effacement of the central sinus.
Intravenous urography revealed dilatation of the right pelvicalyceal system, clubbing of the calyces, dilatation of both ureters (R>L), with loss of renal parenchymal on the right. The urinary bladder had multiple undulated mass compressions and a post-void film showing significant residual volume of urine. All features were consistent with obstructive uropathy, hydronephrosis with chronic right pyelonephritis.
An assessment of renal impairment secondary to post-renal cause in the form of uterine leiomyoma was established.
She was scheduled for a hysterectomy. Intraoperative findings included huge multiple fibroids consistent with a 24weeks pregnant uterus, moderate adhesions, a left ovary bounded to the left fallopian tubes and ovarian ligament. A total abdominal hysterectomy with left salpingo-oophrectomy was done. Estimated blood loss was 600mls.
The subsequent pathological specimen confirmed the diagnosis of uterine leiomyoma with no evidence of leiomyosarcoma.
Mrs E.O was able to urinate normally with complete resolution of oedema and continued to demonstrate normal kidney function tests.
This report demonstrates a rare complication of uterine fibroid, that of compression of the urinary system leading to kidney failure. If such occurs it is strongly recommended that a hysterectomy be performed in order to prevent complete damage to the kidneys, which today is a major cause of death in women.