A 33-year-old unmarried female presented with an abdominal mass matching a 34 to 36 week gestation size. Advanced imaging revealed a giant fundal intramural uterine leiomyoma causing severe mechanical compression of retroperitoneal structures. This led to complete left common iliac vein obstruction, extensive acute iliofemoral deep vein thrombosis, and secondary right hydroureteronephrosis, managed via a multidisciplinary staged approach.
Pelvic masses rarely present with acute vascular emergencies that mimic advanced compression syndromes. When benign tumors grow to massive proportions, they exert profound mechanical effects on surrounding vascular and urological architectures. This case highlights a complex clinical intersection between gynecology and vascular medicine, requiring precise diagnostic imaging and a carefully timed intervention sequence to preserve patient safety and future fertility.
In Plain English: The Clinical Takeaway
- Mass Effect: A very large uterine fibroid physically squeezed the major blood vessel draining the left leg, stopping normal blood flow and causing a massive blood clot known as deep vein thrombosis (DVT).
- Multidisciplinary Strategy: Doctors treated the immediate clot risk first using advanced catheter-based techniques and a protective filter before performing surgery on the fibroid itself.
- Fertility Preservation: Despite the severe presentation, the surgical team successfully removed the giant fibroid while protecting the patient’s reproductive organs.
Anatomical Compression and Vascular Pathology
Uterine leiomyomas are highly prevalent benign smooth muscle tumors of the uterus. However, exceptional growth can transform a routine gynecological finding into a life-threatening systemic crisis. According to findings published in the journal Cureus and detailed in related gynaecological literature, the patient presented with a giant fundal intramural leiomyoma. The sheer physical bulk of the mass caused profound mechanical compression on retroperitoneal structures.
This persistent external pressure resulted in the complete obstruction of the left common iliac vein. When a major venous conduit is occluded, blood pools in the lower extremity, precipitating extensive acute iliofemoral deep vein thrombosis. Furthermore, the mass extended its mechanical disruption to the contralateral side, compressing the right distal ureter and inducing secondary right hydroureteronephrosis, a condition where urine backs up and swells the kidney.
| Clinical Parameter | Patient Presentation / Intervention Detail |
|---|---|
| Patient Demographics | 33-year-old unmarried female |
| Tumor Characteristics | Giant fundal intramural uterine leiomyoma (34–36 week gestation size) |
| Vascular Complication | Complete left common iliac vein obstruction with extensive iliofemoral DVT |
| Urological Complication | Right distal ureter compression causing secondary right hydroureteronephrosis |
| Initial Intervention | Percutaneous endovascular mechanical thrombectomy, balloon angioplasty, and suprarenal IVC filter placement |
| Secondary Intervention | Open minilap myomectomy with prophylactic bilateral uterine artery ligation under therapeutic anticoagulation |
The Staged Multidisciplinary Intervention
Managing a patient with both a massive pelvic tumor and an acute, extensive blood clot requires balancing competing surgical priorities. Immediate surgical removal of the fibroid carries an unacceptably high risk of dislodging the thrombus, leading to fatal pulmonary thromboembolism. Consequently, the medical team deployed a sequential, multidisciplinary strategy involving both vascular specialists and gynecological surgeons.
Initially, the patient underwent percutaneous endovascular mechanical thrombectomy to clear the clot burden. This was paired with balloon angioplasty and the placement of a suprarenal inferior vena cava (IVC) filter to catch any migrating emboli before they reached the lungs. Forty-eight hours following the endovascular stabilization, the patient underwent a successful fertility-preserving open minilap myomectomy. Surgeons combined this tumor resection with prophylactic bilateral uterine artery ligation to control intraoperative hemorrhage while maintaining therapeutic anticoagulation protocols.
Contraindications & When to Consult a Doctor
Conversely, immediate surgical myomectomy is contraindicated in the presence of acute, unmanaged proximal venous thrombi due to the high risk of pulmonary embolism.
The Evolving Landscape of Pelvic Compression Management
This case underscores the critical importance of recognizing rare vascular complications associated with benign pelvic tumors. By dismantling the treatment timeline into discrete, specialty-coordinated phases, modern medical centers can successfully resolve acute thromboembolic emergencies while safeguarding anatomical integrity and endocrine function. As diagnostic imaging tools and endovascular techniques continue to evolve, multidisciplinary care remains the gold standard for managing complex gynecological pathologies that cross into vascular and urological domains.
References
- Cureus. Extensive Iliofemoral Deep Vein Thrombosis Secondary to Uterine Leiomyoma-Induced Iliac Vein Compression: A Case Report.
- Gynaecology Journal. Case report: Giant uterine leiomyoma causing left iliac vein compression, extensive deep vein thrombosis, and hydroureteronephrosis: A fertility-preserving multidisciplinary approach. Vol. 10, Issue 4.
Disclaimer: This article is for informational purposes only and does not constitute formal medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
