Diagnosis and treatment of pelvic lipomatosis / 中华泌尿外科杂志

ABSTRACT

Objective To improve the awareness of pel vi c lipomatosis in clinical practice. Methods A 51-year- old male patient with pelvic lipomatosis was admitted. Imaging studies showed th at there was mild degree of hydronephrosis on his both sides on IVU and a typica l inverted-pear shape of bladder and extended posterior urethra were also seen on IVU.CT scan showed that low density lipid piled in the pelvic cavity.MRI show ed obvious thickened soft tissue lesion around the bladder,rectum and in the pel vic cavity. The lesions in the pelvic cavity and around the ureters were removed and the lower segments of the ureters were loosened by laparoscopic surgery. Th e clinical characteristics of lipomatosis were reviewed by combination with the literature. Results Intraoperatively,apparently increase d lipid tissue was found in the pelvic cavity and there was large amount of lipi d tissue filling the space around bladder,rectum and sigmoid colon.This finding was consistent with the imaging study findings.About 500g lipid tissue was remov ed in the laparoscopic procedure.Pathologic study showed it was mature lipid tis sue.The patient was discharged 1 week after surgery.Two weeks after surgery,B-u ltrasound showed that there was improvement of hydronephrosis on both sides.The maximum width of right renal fluid sonolucent area decreased from 2.9 cm to 2.0 cm;the width of right upper ureter decreased from 1.2 cm to 1.0 cm;the maximum w idth of left renal pelvis decreased from 1.8 cm to 1.3 cm;and the width of left upper ureter decreased from 0.8 cm to 0.5 cm. Conclusions X-ray,CT scan and MRI are the most valuable examinations in the diagnosis of lipomatosis.Removing the lipid in the pelvis and around the bladder and loosenin g the ureters by laparoscopic surgery are minimally invasive,safe and effective in the treatment of pelvic lipomatosis.