Giant cervical uterine leiomyoma associated with bilateral ureterohydronephrosis and retroperitoneal perinephric urinoma at the left kidney: A case report and

TL;DR

A rare case of a large cervical uterine tumor causing kidney issues was successfully treated with surgery.

Contribution

This case report highlights the diagnostic and surgical challenges of a giant cervical leiomyoma with associated urinary complications.

Findings

A 51-year-old woman had a giant cervical leiomyoma causing bilateral ureterohydronephrosis and a retroperitoneal urinoma.

Surgical removal of the tumor and monitoring of the urinary system led to full kidney recovery.

The case emphasizes the complexity of managing such rare gynecological tumors.

Abstract

The present case report describes the successful surgical treatment of a rare case of a giant cervical leiomyoma of the uterus associated with bilateral ureterohydronephrosis and the formation of a retroperitoneal perinephric urinoma in the left kidney. A 51-year-old patient presented with urinary retention, constipation, and lower abdominal pain radiating mainly to the lumbar region. A clinical examination revealed a small amount of vaginal bleeding, with the uterine fundus palpable ~2 cm below the navel. Imaging with computed tomography and magnetic resonance imaging revealed the presence of a giant cervical leiomyoma of the uterus occupying the entire pelvis, causing compressive effects on the ureters, resulting in bilateral ureterohydronephrosis and the formation of a retroperitoneal urinoma at the level of the left kidney. Tumor markers were negative. It was decided to perform a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The hysterectomy was technically difficult, and the traumatic rupture of the bladder was unavoidable. Surgical drainage of the urinoma was not deemed necessary. The urologists recommended monitoring of the lesion and the post-operative retention of ureteral stents to manage the dilations of the pelvicalyceal system. A histopathological examination of the surgical specimen confirmed the diagnosis of cervical leiomyoma of the uterus. The post-operative course was smooth. Urination was restored without issues following the removal of the urinary catheter. The ureteral stents were removed at 3 months after the surgery, at which time point, the ultrasound examination of the urinary system revealed the complete restoration of the morphology of the kidneys. After the detailed description of this rare case, particular emphasis is placed on the challenging preoperative diagnostic approach and the significant intraoperative difficulties in the effective surgical management of giant cervical leiomyomas of the uterus to ensure the best postoperative outcome.

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