GOLDING ET AL.: BILATERAL URETERIC OBSTRUCTION zyx 69 zy SHORT NOTES OF RARE OR OBSCURE CASES BILATERAL URETERIC OBSTRUCTION CAUSED BY BENIGN PELVIC LIPOMATOSIS BY P. L. GOLDING,* M. SINGH, AND B. WORTHINGTONt DEPARTMENTS OF MEDICINE, UROLOGY, AND RADIOLOGY, THE LONDON HOSPITAL SUMMARY A second case of bilateral ureteric obstruction owing to diffuse pelvic ~ipomatosis is reported. The discussed. The condition may be mistaken for a pelvic neoplasm due to high fixation of the bladder and colon, but it is felt that the diagnosis can be made on the basis of characteristic radiological findings. Surgical intervention is unsuccessful in replacing the bladder and colon to their normal positions but may be necessary for relief of obstruction. that time showed a high bladder, left hydronephrosis, and a normal right ureter. At cystoscopy, which was difficult because of the position of the bladder, there appeared to be clinical features and possible aetiological factors are a papilliferous change at the bladder neck, but biopsy of ENGELS (1959) first described a very unusual condi- tion in which the bladder and sigmoid colon are surrounded, elevated, and compressed by seemingly normal but grossly excessive amounts of fat. Since then 6 other cases have been added by Leuzinger, Bahr, Miller, and Shipman (1961) and Fogg and Smyth (1968)~ and a case with some similar patho- logical features but without visceral displacement was reported by Bender and Kass (1970). The condition is rare and has hitherto been regarded as entirely innocuous. We report here a case with severe bilateral ureteric obstruction, the second example in the literature where the ureters have been affected (Bender and Kass, 1970). The condition is quite different from pericystitis or retroperitoneal fibrosis and probably constitutes a separate disease entity related perhaps to other visceral lipodystrophies. It presents a number of difficulties in diagnosis and management which raise problems of unusual practical and theoretical interest. CASE REPORT D. B., a merchant seaman, aged 39 years, first began at the age of 26 (1956) to have attacks of vague central abdominal pain which became gradually worse. By 1960 he was getting recurrent attacks of low-grade fever, nausea, vomiting, headaches, frequency of micturition, and dysuria. He was constipated, producing ribbon-like stools surrounded by large amounts of mucus but no blood. In February, 1964, now aged 34, he complained of suprapubic tenderness and was found to have a large irregular tender mass arising from the pelvis. He was admitted to St. Peter’s Hospital under Mr. D. M. Wallace. zyxwvu An I.V.P. at zyxwvu * Requests for reprints to Dr. P. L. Golding, Depart- ment of Medicine, The London Hospital, Whitechapel, London, E.I. 6 t Present address : Nottingham Group Hospitals. FIG. r.-I.V.P. in zyxwv June, zyxwv 1964. The bladder is seen zyx to be pear- shaped with its fundus projecting out of the pelvis. The collecting tract on the left side is grossly dilated and there is commencing dilatation on the right. this showed only polypoidal cystitis and epithelial hyper- plasia. At laparotomy on 21 Feb., 1964, the bladder and sigmoid colon were found to be displaced upwards by a large amount of fat filling the pelvis. Although the left ureter was distended, no definite obstruction could be found. On opening it, bougies were easily passed through the ureteric orifice into the bladder. Following operation his former symptomsremained and, in addition, he began to suffer perineal ache and soreness. Four months after operation an I.V.P. showed some dilatation of the other (right) ureter and an increasing hydronephrosis of the left (Fig. I). Cystoscopy in July, 1964, and September, 1965, demonstrated the left half of