|Year : 2001 | Volume
| Issue : 1 | Page : 82-83
Pelvic lipomatosis - a rare aetiology of bilateral ureteric obstruction
Tejanshu Shah, Kirtipal Visshana, Rajesh Arora, Himanshu Shah, Manish Patel
Department of Urology, Institute of Kidney Diseases & Research Centre, Civil Hospital, Ahmedabad, India
Department of Urology, Institute of Kidney Diseases & Research Centre, Civil Hospital, Ahmedabad
Source of Support: None, Conflict of Interest: None
Keywords: Pelvic Lipomatosis; Ureteric Obstruction; Periureteral Sheath
|How to cite this article:|
Shah T, Visshana K, Arora R, Shah H, Patel M. Pelvic lipomatosis - a rare aetiology of bilateral ureteric obstruction. Indian J Urol 2001;18:82-3
| Case Report|| |
A 53-year-old male patient presented with fever and rigors and right loin pain. On examination, he had right renal lump and on rectal examination, prostate was not palpable.
S. creatinine was 1.7 mg%, USG showed bilateral hydronephrosis and hydroureter. MCU showed huge capacity bladder with elevated bladder neck but no reflux. Bilateral PCN was kept. Serum creatinine normalised to 1.2 in-%. Bilateral nephrostogram showed gross hydronephrosis with deviation and tortuosity of ureter and failure of dye to drain.
On cystoscopy, there was difficulty in reaching bladder neck. Right RGP showed tortuous ureter. Left ureteric orifice was not identifiable. CT scan showed retroperitoneal and pelvic lipomatosis. On exploration, both ureters encased in fat were dissected free keeping periureteral sheath and D-J stents. Excessive fatty tissue excised from pelvis and retroperitoneum. Histopathology showed mature fat cells with chronic nonspecific inflammation.
Postoperatively PUC was kept for 14 days. Subsequently bilateral PCN were blocked and removed after nephrostogram. Serum creatinine remained at 1.2 mg%.
| Comments|| |
Although a rare condition, its existence should be kept in mind in bilateral ureteric obstruction in obese patient in absence of other causes. CT scan is conclusive for diagnosis.
Dissection of ureter and excision of fat was difficult and time consuming but not impossible. Re-implantation of ureter is not necessary. Response to surgery is good but recurrence is possible. Regular follow-up and weight reduction are important postoperative follow-up advice.
| References|| |
|1.||Joshi KK. Wise HA. Pelvic lipornatosis: 9-year follow-up in a woman. J Urol 1983: 129: 1233-1234. |
|2.||Heyns CF. Pelvic lipomatosis: a review of its diagnosis and management. J Urol 1991: 146: 267-273 |
[Figure - 1], [Figure - 2], [Figure - 3]