症例(증례) : 자궁내막 증에 의한 물요관콩팥증 1예

Hydroureteronephrosis caused by endometriosis is rare and timely diagosis is important to prevent loss of renal function. A 49-year-old woman was referred to our hospital for left flank pain. Enhanced computed tomography demonstrated severe hydroureteronephrosis on left kidney and 1.5 cm-sized mass around left ureter on the level of crossing iliac vessel. The mass compressed distal ureter externally. And there were no other mass lesion or enlarged lymph nodes. For obtaining the character of the mass, an image of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) was taken. It showed also severe hydroureteronephrosis caused by nodular mass in left distal ureter but there was no hypermetabolic lesion. Retrograde pyelography showed narrowing of distal ureter with difficulty of upstream of dye. In this case, excision of mass and adhesiolysis, placement of ureteral stent for stricted site were performed by open surgery. The pathologic exam of resected tissue revealed that it was endometriosis. So gonadotropins were administered immediately. In conclusion, hydroureteronephrosis caused by endometriosis should be included in the differential diagnosis of obstructive uropathy in women. Awareness of clinical features and high index of suspicion can help in early detection and proper management and convincing that associated mass is not malignant, it is possible to avoid open surgery in certain cases