Журнал женского здоровья
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Double trouble leiomyoma- a twisted leiomyoma as a cause of an obstructive acute pyelonephritis

Ana Isabel Cunha1*, Catarina Peixinho2, Diana Arteiro2, Pedro Tiago Silva2

A 57-year-old woman presented to the emergency department with a clinical condition suggestive of renal colic. The image exams showed several non-obstructive right kidney stones, a discrete right kidney ectasia and a poliomyomatous uterus. She was discharged after improvement with analgesia. Four days later, the woman presented with strong right iliac fossa pain, nausea and diminished bowel activity. She had signs of peritoneal irritation and the CT scan demonstrated right moderate uretero-hydronephrosis related to pelvic ureter compression by uterine leiomyomas. The patient was treated with right retrograde ureteral stent placement and endovenous antibiotics with improvement. In the follow-up period, the decision was to perform an abdominal hysterectomy due to the presence of an enlarged poliomyomatous uterus, with a subserous posterior polylobulated myoma with 100*72*52 mm. The surgical exploitation showed two posterior subserous myomas with a twisted common pedicle and a necrotic appearance. The post-surgical period was uneventful.