A CASE OF RETROPERITONEAL FIBROSIS SECONDARY TO SURGERY FOR RECTAL CANCER

Abstract

A 64-year-old woman underwent a low anterior resection of rectum for rectal carcinoma (Rs) in November 2005. One month later she suddenly had lower abdominal pain and low back pain. Moreover the sudden onsets of oliguria and increases BUN and creatinine occurred, and bilateral hydronephrosis was demonstrated by an abdominal CT scan. Retrograde radiography disclosed annular stricture in the bilateral ureters and medial deviation of the ureters. Medication with oral prednisolone at a dose of 10mg/day was started with a diagnosis of retroperitoneal fibrosis, and a stent was placed in the right ureter. Then the urinary output promptly increased, BUN and creatinine levels were normalized, and low back pain was relieved.
Retroperitoneal fibrosis is characterized by extensive fibrotic encasement of retroperitoneal tissue. It causes stricture and obstruction of the ureters and vessels. It often presents with hydronephrosis. Although about 70% of cases are idiopathic, possible correlations with malignant tumors, infection, and drugs have been suggested. This disease must be suspected for bilateral hydronephrosis of unknown origin and early treatment is important in that case.