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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 216-218

Huge pelvic lipomatosis as an unusual cause of acute urinary retention


1 Department of Surgery, Urology Division, Nnamdi Azikiwe University, Anambra, Nigeria
2 Department of Surgery, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria

Date of Submission30-Aug-2021
Date of Decision20-Jan-2022
Date of Acceptance24-Jan-2022
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Joseph Amauzo Abiahu
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_159_21

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  Abstract 


Pelvic lipomatosis is a benign tumor of adipose tissues rarely seen in young males. Its clinical presentation is variable. Acute urinary retention is unusual pattern of presentation. This reports a case and management of huge pelvic lipomatosis in a 33-year-old African male presenting with lower urinary tract symptoms and acute urinary retention. The relevant literatures were also reviewed.

Keywords: Acute urinary retention, lower urinary tract symptoms, pelvic lipomatosis


How to cite this article:
Abiahu JA, Orakwe DE, Mbaeri TU, Onu OA, Odo C. Huge pelvic lipomatosis as an unusual cause of acute urinary retention. Niger J Med 2022;31:216-8

How to cite this URL:
Abiahu JA, Orakwe DE, Mbaeri TU, Onu OA, Odo C. Huge pelvic lipomatosis as an unusual cause of acute urinary retention. Niger J Med [serial online] 2022 [cited 2022 Jul 4];31:216-8. Available from: http://www.njmonline.org/text.asp?2022/31/2/216/344377




  Introduction Top


Pelvic lipomatosis is a benign, progressive infiltrative disease characterized by deposition of mature adipose tissue in the pelvic cavity with the absence of delimitation by a capsule, associated with elevation and compression of the urinary bladder and rectum.[1] This rare phenomenon was first reported in the English literature by Engels[2] but the term “pelvic lipomatosis” was coined by Fogg and Smyth in 1968.[3] The incidence of pelvic lipomatosis has been reported in the American population to be 0.6–1.7/100,000 hospital admissions with a male predominance and peak incidence occurring in the fourth and fifth decades.[4] There is racial disparity with preponderance in individuals with dark-skinned phenotype.[4]

Although the cause is unclear, several theories have been proposed to explain the etiology. Some have proposed pelvic lipomatosis to be a part of general obesity while others have described it as a variant of generalized lipomatosis such as Dercum's disease.[5],[6] It has also been attributed to repeated inflammation from recurrent urinary tract infections or from some hormonal or metabolic imbalance.[1],[7] However, none of these have been confirmed.

The symptomatology of pelvic lipomatosis arises from the compressive effects on adjacent viscera: rectum, urinary bladder, ureters, blood vessels, and nerves. These symptoms may include lower urinary tract symptoms (LUTS) and complications from obstruction of urine flow, changes in bowel habits, chronic pelvic pains, and leg swelling.

The physical examination findings may be variable, traceable to the mass effect caused by the pelvic lipoma.

Although abdominopelvic ultrasound scan and plain abdominal radiograph are useful in making diagnosis, the imaging modality of choice is computed tomography scan.[8] Plain computerized tomogram will show deposition of homogenous tissue with low attenuation (−40 to −100 HU), signifying fatty tissue in the pelvis, while the contrast urogram may demonstrate the typical “teardrop” bladder due to bladder compression and other features of obstructive uropathy.[9]

Treatment is essentially surgical. The primary treatment is surgical excision. Secondary surgical options include nephrostomy, ureteric reimplantation, and simple cystectomy with urinary diversion.[4],[10] These may be indicated in associated complications of the urinary tract. Bladder-sparing complete extirpation of the pelvic fat mass seems the preferred surgical option in young patients but is associated with surgical challenges with increased risk of bleeding posed by increased vascularity within the fatty masses and their intimate association with vascular structures.[11],[12] However, the long-term efficacy of this is still not proven.

Periodic follow-up is important because cystitis cystica and cystitis glandularis which are known to be premalignant lesions of adenocarcinoma in the urinary bladder has been shown to occur in about 70% of cases.[13] We thus report a case of huge pelvic lipomatosis, an unusual cause of acute urinary retention in a young man.


  Case Report Top


Mr. A. N. is a 33-year-old African trader who presented with difficulty with micturation of 6-month duration and inability to micturate of 2 h. The difficulty was characterized with LUTS of both voiding and storage phase components. Symptoms were progressive and culminated into the inability to micturate 2 h before presentation, associated with severe urge to micturate, suprapubic pain, and swelling. No associated hematuria or prior pain on urination. No change in bowel habit, weight loss, or anorexia. No history of prior purulent urethritis. Patient had free and successful urethral catheterization with drainage of 2L of clear amber urine.

Clinical examination revealed a healthy looking but anxious man. He had normal vital signs. There was suprapubic mass which was nontender, multilobulated, firm, and poorly defined edge. No renal angle tenderness. No organomegaly. He had right irreducible nontender inguinoscrotal mass. The urethral catheter was in-situ, draining clear amber urine. Both testes and epididymis were normal.

Ultrasound scan showed pelvic soft tissue mass extending from the pelvis to the umbilicus, displacing the gut and urinary bladder anteriorly and an incarcerated right inguinoscrotal hernia. Other intrabdominal viscera were normal. A computed tomography (CT) or magnetic resonance imaging (MRI) could not be done due to financial constraints. Other basic investigations were normal. Diagnosis of a pelvic mass with bladder outlet obstruction and incarcerated right inguinoscrotal hernia was made.

The patient was counseled and gave consent for surgery, clinical pictures, and this report. An exploratory laparotomy through extended lower midline incision was done. Intraoperative finding was a huge, multilobulated pelvic fatty tissue extending from the right groin to the pelvis, subhepatic and gastric regions [Figure 1] and [Figure 2]. Excision of fatty tissue and right herniorrhaphy was done. Histology of fatty tissue specimen showed cut sections with yellowish appearance and benign mesenchymal neoplasm composed of matured adipocytes separated into lobules by thin fibrous bands. However, the histopathology slides, microgram, or tissue block could not be found at the time of this report. The patient had uneventful postoperative recovery and remained healthy 3 months after surgery.
Figure 1: Intraoperative picture of huge pelvic lipomatosis with intraabdominal extension

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Figure 2: Postoperative specimen of the fatty tissues

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  Discussion Top


Pelvic lipomatosis was reported by Cruz et al.[1] as benign progressive infiltrative disease with deposition of matured adipose tissues with compressive effect on pelvic viscera. This description fits with this reported case whose histology reported no malignant cells. However, despite the progressive nature of this disease, patients tend to present to the doctor with the onset of symptoms as observed in this reported case. He presented with 2 h history of inability to urinate and background history of LUTS of 6-month duration. Heyns[4] reported a male preponderance of this disease among the black American population with peak incidence at the fourth and fifth decades. This finding is similar to our reported case.

We found abdominopelvic ultrasound useful in diagnosis as reported by Zhao et al.[8] Ultrasound helps to define the site, extent, and nature of the mass and associated compressive or displacement effects on surrounding viscera. However, the superior advantage of CT and MRI in characterizing this mass must be reemphasized.[8],[9]

In this reported case, the patient was offered surgery as suggested by other reporters.[4],[10] However, the option and extent of surgery may be determined by existing pathology and associated complications. The huge resectable pelvic and abdominal fat with right inguinoscrotal extension in this young man with no comorbidities necessitated exploratory laparotomy, excision of fatty tissues, and right inguinal herniorrhaphy. Extirpation of fat mass among young patients with good quality of life was reported as preferred option of surgery.[11],[12]

Heyns CF et al. recommended periodic follow-up of patients treated for pelvic lipomatosis because of the risk of malignant transformation. However, this reported case was lost to follow-up after 3 months.


  Conclusion Top


Pelvic lipomatosis is a benign disease of adipose tissue with the tendency of malignant transformation and rarely causes acute urinary retention in young males.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cruz JM, Vieira Filho MA, Mendes LV, Bezerra AF Jr., Aragão BL, Cruz Filho JM. Pelvic lipomatosis: A case report and literature review. Radiol Bras 2012;45:175-7.  Back to cited text no. 1
    
2.
Engels EP. Sigmoid colon and urinary bladder in high fixation: Roentgen changes simulating pelvic tumor. Radiology 1959;72:419-22.  Back to cited text no. 2
    
3.
Fogg LB, Smyth JW. Pelvic lipomatosis: A condition simulating pelvic neoplasm. Radiology 1968;90:558-64.  Back to cited text no. 3
    
4.
Heyns CF. Pelvic lipomatosis: A review of its diagnosis and management. J Urol 1991;146:267-73.  Back to cited text no. 4
    
5.
Sacks SA, Drenick EJ. Pelvic lipomatosis: Effect of diet. Urology 1975;6:609-15.  Back to cited text no. 5
    
6.
Carpenter AA. Pelvic lipomatosis: Successful surgical treatment. J Urol 1973;110:397-9.  Back to cited text no. 6
    
7.
Morettin LB, Wilson M. Pelvic lipomatosis. Am J Roentgenol Radium Ther Nucl Med 1971;113:181-4.  Back to cited text no. 7
    
8.
Zhao J, Fu YX, Feng G, Mo CB. Pelvic lipomatosis and renal transplantation: A case report. World J Clin Cases 2020;8:3548-52.  Back to cited text no. 8
    
9.
Xia S, Yan Y, Peng B, Yang B, Zheng J. Image characteristics of computer tomography urography in pelvic lipomatosis. Int J Clin Exp Med 2014;7:296-9.  Back to cited text no. 9
    
10.
Ashwin Shekar P, Reddy D. Difficult cystoscopy due to “Elongated” urethra- think of pelvic lipomatosis. Urol Case Rep 2021;34:101492.  Back to cited text no. 10
    
11.
Ali A, Swain S, Manoharan M. Pelvic lipomatosis: Bladder sparing extirpation of pelvic mass to relieve bladder storage dysfunction symptoms and pelvic pain. Cent European J Urol 2014;67:287-8.  Back to cited text no. 11
    
12.
Ge L, Tian X, Zhao G, Ma J, Song Y, Yang F, et al. Surgical treatment for pelvic lipomatosis using a bladder-sparing technique: A STROBE-compliant study. Medicine (Baltimore) 2019;98:e16198.  Back to cited text no. 12
    
13.
Heyns CF, De Kock ML, Kirsten PH, van Velden DJ. Pelvic lipomatosis associated with cystitis glandularis and adenocarcinoma of the bladder. J Urol 1991;145:364-6.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]



 

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