Mumbai, Feb 25: A 59-year-old postmenopausal woman who sought medical care for persistent nausea was found to have a serious underlying condition that had been silently progressing for years. With no abdominal pain, no postmenopausal bleeding, and no clear gynecological complaints, she was initially treated for a urinary tract infection. However, further evaluation revealed acute pyelonephritis caused by ureteric compression from a massive fibroid uterus.
What makes the case particularly significant is that even a simple per abdomen examination revealed a large abdominal mass. A routine gynecological check-up was sufficient to raise suspicion, underscoring the importance of basic clinical evaluations in detecting potentially life-threatening conditions early.
An ultrasound (USG) confirmed the findings, revealing a markedly enlarged fibroid uterus, approximately the size of a 24-week pregnancy. The dominant subserosal fibroid measured nearly 14 cm in diameter, displacing bowel loops and compressing the ureter. This obstruction led to urinary stasis, infection, and posed a significant risk to long-term kidney function. The final surgical specimen weighed 2.8 kilograms — an unusually large fibroid uterus in a postmenopausal woman.
The patient later shared that she had noticed gradual abdominal enlargement over time but assumed it was normal age-related weight gain. The absence of alarming symptoms delayed medical consultation, allowing the fibroid to grow silently.
The case was led by Dr. Hemakshi Mehta, Consultant Obstetrician and Gynaecologist at Apex Superspeciality Hospital, part of Apex Group of Hospitals.
Dr. Mehta highlighted that the timing of surgery posed a significant clinical dilemma. Operating during an active kidney infection carried risks including worsening sepsis and anesthesia-related complications. Conversely, delaying surgery meant continued ureteric compression and potential kidney damage.
To balance these risks, the medical team adopted a carefully staged, multidisciplinary approach. The patient was first stabilized with intensive intravenous antibiotics. A nephrologist closely monitored kidney function and infection markers, while anesthesiologists assessed surgical readiness.
After approximately one month of optimized medical management and complete resolution of infection, the team proceeded with a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Removing a 2.8 kg fibroid uterus via a minimally invasive approach required advanced laparoscopic expertise, meticulous preoperative planning, and seamless coordination between gynecology, nephrology, and anesthesia teams.
The surgery was successfully completed, and the patient experienced a smooth postoperative recovery with preserved kidney function.
A Message for Postmenopausal Women
Dr. Hemakshi Mehta emphasizes that postmenopausal women should not ignore abdominal distension, urinary changes, or vague systemic symptoms.
“Fibroids may grow silently, even after menopause. Regular gynecological evaluations are essential. Early detection allows safer intervention and prevents avoidable complications,” she said.
This case serves as a strong reminder that routine examinations and timely medical attention can prevent severe complications and safeguard long-term health.