Jornal de relatos de casos clínicos

Parasitic Uterine Fibroid Causing Bladder Outlet Obstructions and Urosepsis: A Case Report

Abstract

Enebe JT, Ofor IJ and Edeh AJ

Background: Uterine leiomyomas (fibroids) are the most common neoplasm affecting women. Extrauterine leiomyomas are rare and may arise in any anatomic site; their unusual growth pattern may mimic malignancy and can result in a clinical diagnostic dilemma. Uterine fibroids are not well known to cause acute urinary retention (AUR) and subsequent urosepsis in women, and there have been few published cases of parasitic fibroids causing AUR. We present a case of a parasitic fibroid in the posterior vaginal wall occupying the rectouterine pouch (of Douglas) in a grand multiparous woman causing AUR and urosepsis requiring total abdominal hysterectomy and removal of the parasitic fibroid.

Case report: A 45-year-old business woman, P₈ ⁺⁰ who presented with abdominal swelling and pains and recurrent difficulty in passing urine with total urinary obstruction of five months duration. Abdominal examination revealed 20-weeks uterine size mass that was nodular, firm, non-tender and mobile from side to side. Pelvic examination revealed a healthy-looking cervix that was displaced anteriorly by the huge pelvic mass and occluded the pouch of Douglas. She was resuscitated and had exploratory laparotomy with removal of the mass and total abdominal hysterectomy. She had post-operation septic shock that was managed with intravenous and oral antibiotics. She had quick recovery and was discharged after four days of surgery. Histology confirmed the mass to be fibroid.

Conclusion: Parasitic fibroid can present as a case of bladder outlet obstruction and diagnosis can easily be missed. High index of suspicion, good investigation and institution of appropriate management protocol will ensure quick recovery and reduce further complications as in the case presented.