Pelvic lipomatosis associated with portal vein thrombosis and hydronephrosis: a case report

Özkaçmaz, Sercan

doi:10.1177/0300060519840912

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…Pain (flank or lower abdominal) is the most common symptom, and the wide range of other symptoms is secondary to the compression of pelvic structures—the genitourinary tract (lower urinary tract symptoms, hematuria, HUN, stones, and painful ejaculation), lower gastrointestinal tract (constipation, tenesmus, and rectal bleeding), and vascular system (edema of lower limbs and deep vein thrombosis) [4] , [15] , [16] . Complications include hypertension, renal failure, rarely bladder adenocarcinoma, pulmonary thromboembolism, portal vein thrombosis, and death [17] , [18] , [19] , [20] , [21] , [22] . All our patients presented with B/L flank pain (usually more on one side), and none had azotemia or hypertension.…”

Section: Discussionmentioning

confidence: 99%

Robotic Management of Pelvic Lipomatosis—Experience with Difficulties Encountered and the Techniques to Successful Outcomes

SanjayPrakash¹,

Thangarasu²,

Jain³

et al. 2020

European Urology Open Science

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Background Pelvic lipomatosis (PL) is a rare condition characterized by diffuse pelvic overgrowth of nonmalignant but infiltrative adipose tissue in perivesical and perirectal space. Objective To share our robotic experience and difficulties encountered and suggested techniques to overcome them successfully. It is the first series from India. Design, setting, and participants A prospective observational study was conducted. All consecutive patients diagnosed with PL between 2016 and 2019 underwent robotic-assisted wide bladder fat extirpation and bilateral ureteral reimplantation (extravesical refluxing type) with double J stenting and were evaluated prospectively. Outcome measurements and statistical analysis Demographics, serum creatinine level, radiographic features, postoperative complications, and patient-reported outcomes were evaluated. Continuous variables are presented as median and range, as the sample size is very small. Results and limitations We encountered a total of five patients with PL. The median console time was 126 (range 120–130) min, with a median estimated blood loss of 120 (range 100–150) ml. Postoperative complications were Clavien-Dindo grade I in three cases, and the median hospital stay was 2 d. Distal ureteric margins showed subepithelial edema with submucosal fibrosis, and bladder fat biopsies were reported as adipose tissue with hemorrhage. At initial 3-mo and annual follow-ups, all patients had normal serum creatinine and there was no evidence of disease recurrence. Limitations of our study are the very small sample size (a low incidence of PL) and short follow-up time period (the question of how long the surgical effect will be sustained due to abnormal proliferation of fat cells remains unanswered). Conclusions Robotic management of wide bladder fat extirpation and bilateral ureteral reimplantation with double J stenting has a good success rate and good outcome in PL. Patient summary Pelvic lipomatosis is a very rare condition. Robotic management in treating the condition has good outcome for the patient. Here, we have discussed the difficulties encountered in treating the condition and the techniques used to overcome them.

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Section: Discussionmentioning

confidence: 99%

Robotic Management of Pelvic Lipomatosis—Experience with Difficulties Encountered and the Techniques to Successful Outcomes

SanjayPrakash¹,

Thangarasu²,

Jain³

et al. 2020

European Urology Open Science

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“…For this reason, for example, a small amount of intestinal gas or a low bladder capacity may be found in individuals with significantly increased body weight. In patients with pelvic lipomatosis, not only the bladder, but also the ureters, rectum and veins in this region are compressed (16,17) . Obesity is also a known factor promoting reflux disease, esophageal hiatal hernia or even dysphagia (18,19) .…”

Section: Intra-abdominal Hypertension and Ultrasonographymentioning

confidence: 99%

Ultrasonography in the diagnosis and monitoring of intra-abdominal hypertension and abdominal compartment syndrome

2020

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Despite their considerable clinical significance, intra-abdominal hypertension and abdominal compartment syndrome are rarely discussed in the context of ultrasonography. They occur in critically ill patients, usually hospitalized in intensive care units. Early diagnosis of these conditions is of key importance for prognosis as it allows for proper treatment and prevents high mortality. Although there are various methods for the assessment of intra-abdominal pressure, a measurement using a sensor-equipped catheter placed in the bladder is the gold standard. However, this technique does not allow to identify the etiology of the problem, which is usually resolved by analyzing patient’s clinical data supported by imaging findings. Computed tomography is most often used for this purpose. Recent years have proved that point-of-care ultrasonography is also useful in this respect. This issue has become the basis for developing this review paper, which describes the opinion of the experts of the World Society of the Abdominal Compartment Syndrome on the nomenclature, classification and diagnosis of intra-abdominal hypertension. We also presented preliminary data on the role of ultrasound in the diagnosis and monitoring of intra-abdominal hypertension and the contribution of this modality to the choice of appropriate treatment for patients presenting with this clinical condition. A multi-center study used point-of-care ultrasonography to assess the position of a g-tube in the stomach and its contents, intraluminal content status and bowel motor function, the monitoring of gastric drainage and forced intestinal evacuation, the presence of ascites and ascitic status without and after paracentesis. Even when simplified, the method was found to be very useful.

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Pelvic lipomatosis and renal transplantation: A case report

Zhao¹,

Fu²,

Gao³

et al. 2020

WJCC

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BACKGROUND Pelvic lipomatosis is a rare disease of unknown etiology, characterized by the overgrowth of pelvic adipose tissue that causes compression of the urinary tract including the bladder and ureters, rectum and blood vessels. The patient may progressively develop obstructive uropathy which could subsequently lead to renal failure. At present, there are no reports of renal transplantation due to uremia caused by pelvic lipomatosis. The ideal management of patients with pelvic lipomatosis after renal transplantation is not yet well-established due to the lack of literature and follow-up data. CASE SUMMARY We report a 37-year-old male patient with pelvic lipomatosis who received a successful living donor renal transplantation on July 22, 2015. The operation was complicated as the iliac vessels and bladder were wrapped entirely in excessive abnormal fat. The external iliac artery and vein were located using ultrasonographic guidance. The adipose tissue around the right bladder was removed as far as possible, and the graft ureter was reimplanted into the bladder, using the Lich-Gregoir technique. At 22 mo after transplantation, graft percutaneous nephrostomy was performed under ultrasonographic guidance for urinary diversion due to hydronephrosis of the graft kidney. Follow-up at four years showed that the renal allograft function was stable. CONCLUSION When patients with pelvic lipomatosis develop renal failure, renal transplantation could be a feasible treatment strategy.

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Pelvic lipomatosis associated with portal vein thrombosis and hydronephrosis: a case report

Cited by 3 publications

References 11 publications

Robotic Management of Pelvic Lipomatosis—Experience with Difficulties Encountered and the Techniques to Successful Outcomes

Robotic Management of Pelvic Lipomatosis—Experience with Difficulties Encountered and the Techniques to Successful Outcomes

Ultrasonography in the diagnosis and monitoring of intra-abdominal hypertension and abdominal compartment syndrome

Pelvic lipomatosis and renal transplantation: A case report

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