Intestinal obstruction and bilateral ureteral injuries after laparoscopic oophorectomy in a patient with severe endometriosis and a large endometrioma

A 44-year-old woman presented with right lower quadrant abdominal pain of three months' duration and history of previous Cesarean section and abdominal hysterectomy. Pelvic examination and vaginal sonography revealed a large unilocular mass. Laparoscopy findings included a fixed, large endometrioma severely attached to the pelvic peritoneum and intestines in the pelvic cavity, and significant adhesions in the upper part of the prior midline abdominal hysterectomy incision. Two days after laparoscopic bilateral adnexectomy, she was readmitted with small-bowel obstruction and underwent prompt adhesiolysis via laparotomy. Thirty-nine days later, she presented with massive urinary ascites. Evaluation revealed right ureteral stricture at the uterine artery level and complete ligation and resection of the left ureter at the pelvic brim near the infundibulopelvic ligament stump. Left ureteral reimplantation with psoas hitch and right ureterolysis were performed. We conclude that, in cases of severe endometriosis with significant ureteral and intestinal involvement, laparotomy should be considered.