Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis

Hsing-Yu Chen, Hsing‐Yu Chen, Chen HY, Ming-Chao Huang, Ming‐Chao Huang, Huang MC, Hung YC, Yu-Chung Hung, Yung-Hsuen Hsu, Hsu YH
Taiwanese journal of obstetrics & gynecology · 2006 · vol. 45(2) , pp. 142–145 · doi:10.1016/s1028-4559(09)60212-6 · PMID:17197355 · W2047848001
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This case report describes a patient with hydronephrosis caused by endometriosis, where laparoscopic ureterolysis was unsuccessful, necessitating later ureteral resection and reconstruction.

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Abstract

OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.

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Condition tags

endometriosisendometriomadysmenorrheadyspareunia

MeSH descriptors

Adnexal Diseases Adnexal Diseases Endometriosis Endometriosis Laparoscopy Laparoscopy Ureteral Obstruction Ureteral Obstruction Adnexal Diseases Adnexal Diseases Adnexal Diseases Adult Adult Endometriosis Endometriosis Endometriosis Female Female Humans Humans

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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Cited by (6)

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