Leiomyosarcoma causing obstructive uropathy and acute renal failure

A 41-year-old nulliparous woman presented to the hospital with lower abdominal pain for 15 days and constipation since 1 week and acute retention of urine for 3 days. Ultrasound revealed enlarged uterus with a large posterior wall fibroid with degenerative changes and bilateral mild hydro ureteronephrosis and MRI pelvis with contrast showed 17 × 10 × 12 cm pelvic mass along the posterior wall of the uterus with cystic degeneration and necrosis minimal haemorrhage with multiple fibrotic strands. Enlarged bilateral external internal, right iliac and lymph nodes noted. Laboratory evaluation revealed an elevated urea 101 mg/dl and creatinine levels 9.4 mg/dL with normal myoglobin levels (39 ng/mL). The patient was haemodynamically stable with serum electrolytes and ABG normal. After taking a nephrologist and urologist opinion and proper counselling for exploratory laparotomy +/- hysterectomy, proceeded with total abdominal hysterectomy. Immediate improvement of renal parameters and reversal of renal failure was noted and