Retroperitoneal Fibrosis with Ilio-Caval Tract Obstruction

Abstract

Retroperitoneal fibrosis with ilio-caval tract obstruction is rare. During a 13-year period (1987 ～1999), we encountered four cases diagnosed as retroperitoneal fibrosis with stenosis and obstruction of the iliac vein and inferior vena cava. All the patients were male and their ages ranged from 51 to 79 years and they were all referred to our hospital with the chief complaint of swelling of the lower limbs. We treated one case by surgery and the oral administration of steroids and the other three cases were treated using the oral administration of steroids with satisfactory results. The venous lesions were stenosis of the inferior vena cava in Case 1, obstruction of the left common iliac vein in Case 2, obstruction of the inferior vena cava in Case 3 and stenosis of the right common iliac vein and inferior vena cava in Case 4. The period from the onset of the disease to inception of the steroid oral administration was 10 months, 2 months, 4 months and 12 days respectively. Fibrinolytic therapy using urokinase was administered to Case 2 and 4 prior to the diagnosis of retroperitoneal fibrosis. Diagnosis was made by CT and phlebography in all the cases. Periaortic mass lesion were revealed in all of the cases on CT scan. Phlebography showed the obstruction of the common iliac veins and inferior vena cava. All patients improved after steroid administration. Our findings suggest the importance of early diagnosis by CT and phlebography and early oral administration of steroids in cases of retroperitonoal fibrosis with ilio-caval tract obstruction.