Prolonged Obstructed Labor Is an Uncommon Presentation of a Giant Bladder Calculus: A Case Report and Literature Review

Abstract

Prolonged obstructed labor is a critical intrapartum emergency. This intricacy is, however, unusual as a primary presentation of a giant bladder calculus. We report a case of a 25-year-old Para 6 + 1, who presented with a history of labor pains of 72 hours duration. She had background lower urinary tract symptoms with supra-pubic swelling and hematuria of 2 years duration. She had a single antenatal visit at 32 weeks however; no obstetric ultrasound scan was done before she went into labor. Examination revealed a highly placed fetal head with increase fetal heart rate. There was a hard mass bulging under the anterior vaginal wall. The diagnosis was a prolonged obstructed labor secondary to bladder mass with fetal distress was made. She had a caesarean section (CS) with the delivery of fresh stillborn. The bi-manually palpable bladder mass persisted post-CS. Her abdominopelvic ultrasound scan and abdominal X-ray post-CS revealed giant vesical calculus with obstructive uropathy. Urine microscopy culture and sensitivity yielded E. coli sensitive to Ciprofloxacin; other laboratory investigations were normal. She was treated for UTI and 2 weeks post-CS, she had opened cystolithotomy. The stone weighed 536 g. Her postoperative recovery was uneventful.