Obstruction from endometriosis causing hydronephrosis and complex renal pelvis rupture: A case report

Endometriosis presents a diagnostic conundrum due to its diverse clinical manifestations, ranging from asymptomatic to acute obstructive uropathy. This is a case of a 30-year-old woman with a history of endometriosis and rapidly progressing left flank pain culminating in rupture of the renal pelvis in her left kidney. Initial investigations revealed left-sided hydronephrosis without evidence of nephrolithiasis. Subsequent imaging showed active extravasation indicative of urinary obstruction attributable to endometriosis. Placement of a left nephrostomy tube alleviated her symptoms, and follow-up imaging revealed a distal ureteral stricture. A stent was subsequently placed, which resolved the obstruction and obviated the need for extensive surgical intervention. In this case, the patient's history of endometriosis prompted consideration of its role in urinary obstruction, despite the absence of typical symptoms, and underscores the importance of considering endometriosis as a potential cause of acute urinary obstruction, particularly in patients with a history of the disease. Physicians in the emergency department should maintain a high index of suspicion for endometriosis-related complications to facilitate timely intervention and prevent adverse outcomes. Awareness of the variable presentations of endometriosis is paramount for ensuring comprehensive patient care and optimal outcomes. • Acute obstructive uropathy due to endometriosis can mimic other conditions, complicating diagnosis. • Endometriosis is an import cause of acute urinary obstruction, potentially leading to renal pelvis rupture. • Severe left flank pain with negative CT findings should raise suspicion of endometriosis. • Diagnosis of endometriosis in patients often requires a thorough consideration of reported medical history. • Nephrostomy tube placement with or without urinary stenting can decompress urinary obstructions.