Uterine Leiomyoma Presenting With Acute Urinary Retention and Abnormal Uterine Bleeding

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CLINICAL CASE REPORT

1. Patient Information

  • Age: 43 years
  • Sex: Female
  • Obstetric History: P2L2
  • Previous Surgical History: Bilateral tubal ligation 16 years previously

2. Presenting Complaints

The patient presented with:

  • Acute urinary retention
  • Abnormal uterine bleeding
  • Dysmenorrhea with occasional passage of clots

Her menstrual cycles were regular, occurring every 28–30 days, with 5–6 days of menstrual flow.

3. History of Present Illness

The patient developed acute urinary retention approximately two days before hospital admission and was catheterized prior to arrival. She also reported abnormal uterine bleeding associated with dysmenorrhea and occasional clots.

4. Clinical Examination

General Examination

  • Mild pallor was present.
  • No icterus, cyanosis, or pedal edema was noted.
  • The patient was afebrile and hemodynamically stable.

Vital Signs

  • Pulse: 76/min
  • Blood Pressure: 112/78 mmHg
  • SpO₂: 98% on room air
  • Temperature: Afebrile

Pelvic Examination

Per-vaginal examination revealed a firm and mobile uterus approximately 12 weeks in size. Bleeding through the cervical os was noted. The findings were suggestive of uterine leiomyoma.

5. Investigations

Ultrasonography

Ultrasonography revealed:

  • Enlarged uterus
  • Approximately 8 × 10 cm intramural fibroid
  • Endometrial thickness: 12 mm

Laboratory Investigations

  • Hemoglobin: 10.5 g/dL
  • HbA1c: 5.9%
  • TSH: 4.79 µIU/mL
  • Liver and kidney function tests: Within acceptable limits

Urinalysis revealed calcium oxalate crystals.

6. Diagnosis

Uterine leiomyoma (large intramural fibroid) associated with abnormal uterine bleeding and acute urinary retention.

7. Management and Hospital Course

The patient was initially admitted for management of acute urinary retention and abnormal uterine bleeding. A urinary catheter was maintained initially and subsequently removed after clinical improvement. Following catheter removal, the patient was able to void urine normally.

Dilation and curettage (D&C) was performed, and the obtained tissue was sent for histopathological examination and CBNAAT.

The patient was subsequently readmitted for further definitive surgical management. Hysterectomy was planned as the definitive treatment.

8. Discharge Management

At discharge, the patient was advised:

  • High-protein diet
  • Increased oral fluid intake
  • Iron supplementation
  • Calcium supplementation
  • Vitamin C supplementation
  • Analgesic medication as required
  • Antibiotic therapy as prescribed

9. Clinical Outcome

Following catheter removal, spontaneous urination was restored. The patient underwent D&C for further evaluation, with tissue sent for laboratory assessment. Definitive surgical management with hysterectomy was planned.

10. Discussion

Uterine leiomyomas are common benign tumors of the uterus and may present with abnormal uterine bleeding, dysmenorrhea, pelvic pressure, and urinary symptoms. Large intramural fibroids can cause pressure effects on adjacent pelvic structures, and in some cases may contribute to urinary retention. In this case, the presence of a large intramural fibroid with an enlarged uterus was associated with abnormal uterine bleeding and acute urinary retention.

11. Conclusion

A large uterine leiomyoma should be considered in women presenting with abnormal uterine bleeding and acute urinary symptoms. Appropriate clinical examination and imaging help establish the diagnosis and guide definitive management.

12. References

  1. American College of Obstetricians and Gynecologists. Uterine fibroids.
  2. Stewart EA. Uterine fibroids. New England Journal of Medicine.
  3. FIGO. Classification and management of uterine fibroids.

 

Medical Disclaimer: The information provided in this article is strictly for educational, study, and exam-preparation purposes. It does not constitute professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for clinical decisions.

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