Deep infiltrating ureteral endometriosis with catamenial hydroureteronephrosis: a case report

Hyun Jung Lee, Yoon Soon Lee
Journal of medical case reports · 2017 · vol. 11(1) , pp. 346 · doi:10.1186/s13256-017-1518-6 · PMID:29233171 · PMC5728068 · W2772336931
article OA: gold CC0 ⤵ 4 in-corpus citations
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This case report describes a 44-year-old woman with cyclic flank pain and hydronephrosis diagnosed with right ureteral endometriosis causing distal ureteral obstruction.

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Abstract

BACKGROUND: This aim of this case report is to raise awareness of ureteral endometriosis in women of reproductive age with hydronephrosis in the absence of urolithiasis to enable early diagnosis and prevent loss of renal function. CASE PRESENTATION: A 44-year-old Asian woman presented with a 4-year history of cyclic right flank pain and right hydronephrosis during menstruation. Despite several evaluations by physicians, including gynecologists, the cause of her symptoms was not diagnosed. On transvaginal ultrasonography, the uterus was observed deviated to the right, with a nodular lesion at the right uterosacral ligament, and the right ovary was attached to the uterus with no apparent cystic lesion. Magnetic resonance imaging showed a mass in the right uterine wall and mild wall thickening with delayed enhancement of the right distal ureter. Right ureteral endometriosis was suspected. Diagnostic laparoscopy revealed narrowing of the distal right ureter between the right uterosacral ligament and the right ovary with adhesions caused by deep infiltrating endometriosis. The adhesion bands and infiltrating endometriosis around the right ureter were dissected. CONCLUSIONS: The nonspecific symptoms of ureteral endometriosis can result in incorrect diagnosis, with renal damage as a result of prolonged hydronephrosis. A high index of suspicion and use of imaging modalities enable earlier diagnosis and preservation of renal function.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Hydronephrosis Ureteral Diseases Adult Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Constriction, Pathologic Dilatation Endometriosis Endometriosis Endometriosis Female Humans Hydronephrosis Hydronephrosis Hydronephrosis Laparoscopy Magnetic Resonance Imaging Radiography, Abdominal

Citation neighborhood

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References (14)

Cited by (4)

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License: CC0 · commercial use OK