• Anuria and confusion

      D'Souza, N; Winter-Roach, Brett; The Christie NHS Foundation Trust, Manchester, (2021)
      Background The differential diagnoses of postoperative disorientation and anuria can be streamlined with prompt initiation of the management protocol to investigate these symptoms. This case report describes a woman who underwent primary cytoreductive surgery for an ovarian mass and the postoperative events that lead to the diagnosis of an incidental intra-cranial meningioma. Case A 61 year old woman was diagnosed with a large left ovarian mass on evaluation of abdominal pain. Primary cytoreductive surgery was performed. On the first postoperative day, she developed anuria and disorientation associated with a creatinine rise despite being haemodynamically stable. A CT head done as part of the delirium screen revealed an extra-axial bilobed mass favouring a meningioma rather than a metastasis. Despite the brain mass, she had no neurological symptoms. Her renal function was closely monitored and recovered by the fifth postoperative day. It was thought to be likely due to postsurgical ureteric oedema related to ureteric catheterisation. She underwent craniotomy at a tertiary care centre 2 months after the laparotomy. Histopathology of the ovarian mass was grade 2 endometrioid adenocarcinoma, FIGO Stage 1C2; the cranial tumour was an anterior cranial fossa meningioma (benign). She had no neurological deficit and had completed adjuvant chemotherapy a year after these events. Conclusion Synchronous ovarian and brain tumours can be a diagnostic challenge and are best managed by a multidisciplinary team. Meningiomas can be asymptomatic despite their size. A high index of suspicion is required to aid early detection in order prevent loss of functional ability