Endometriosis A Missed and Complicate Diagnosis: Case Report of Ureteral Endometriosis

Ureteral endometriosis is a rare and under diagnostic condition, defined as “the silent killer” of the kidney. The incidence of ureteral endometriosis varies from 0, 1% to 1 %. Although it is relatively a rare and uncommon pathology, affecting a very small number of women of reproducing age, it is of particular importance because of its silent and severe loss of renal function towards renal failure. Despite its presentation, both intrinsic and extrinsic ureteral endometriosis, present a diagnostic and therapeutic challenge. Aim: The purpose of our presentation is to turn the attention of the clinicians toward rare conditions in order to provide an accurate approach for differential diagnosis and lead to accurate therapeutic procedures. Method: we will represent a case report of a 42 years’ woman diagnosed with extrinsic ureteral obstruction and hydronephrosis of the right kidney, suspected for metastasis from cervical or endometrial carcinoma. She undergoes surgical procedures that relieve the obstruction. The pathological examination diagnosed extrinsic ureteral endometriosis. After six months the patient was suspected again for extrinsic ureteral obstruction and is under examinations for further diagnosis and treatment. Conclusions: Although the preoperative diagnosis is essential for an appropriate surgical approach, the diagnosis of ureteral endometriosis is sometimes negligible and missed because of the unclear clinical signs and because they do not display typical symptoms. In these conditions recurring cases become frequent, making the treatment difficult and complicate.