BILATERAL HYDROURETERONEPHROSIS AS A SEQUELAE OF PELVIC LIPOMATOSIS: A RARE CASE REPORT

Abstract

Background: Pelvic lipomatosis as a cause of incidental bilateral hydrouereteronephrosis is very rare. It is considered a benign condition but can cause variable symptoms and presentations due to compression of pelvic organs, although it is mostly asymptomatic. The symptoms can include urinary tract obstruction which can cause deranged renal function tests, constipation, tenesmus, lower limb oedema and deep venous thrombosis.
Case: We present a case of incidental bilateral hydroureteronephrosis resulting from compression of distal ureters by pelvic lipomatosis identified on KUB ultrasound (kidney, ureter, bladder) in a patient being evaluated for infertility. This prompted further evaluation with CT urography which revealed abundance of fat in the pelvis surrounding the bladder resulting in extrinsic compression and elevation as well as surrounding the rectum and sigmoid colon with elongated sigmoid colon and peripherally displaced bowel loops. There was also moderate bilateral hydroureteronephrosis with tapered narrowing of the ureters in the distal third (just below the pelvic brim.
Conclusion: Pelvic lipomatosis is a rare benign condition which is mostly asymptomatic but can present with symptoms due to compression of the pelvic organs with subsequent systemic symptoms such as hypertension. Radiological cross-sectional imaging with CT scan or MRI is adequate for accurate diagnosis and identification of some of the associated complications of this very rare condition.