Rectosigmoid deep infiltrating endometriosis and ureteral involvement with loss of renal function

Muñoz JL, José Luís Bernal Muñoz, Jose L Muñoz, Jesús S. Jiménez López, Jesus S Jiménez, Alvaro Tejerizo, A. Tejerizo-García, Tejerizo A, Gregorio López González, Gregorio Lopez, Lopez G, Jose Duarte, Duarte J, José Duarte, Fernando Sánchez Bustos, Sánchez Bustos F
European journal of obstetrics, gynecology, and reproductive biology · 2012 · vol. 162(2) , pp. 121–124 · doi:10.1016/j.ejogrb.2012.02.030 · PMID:22534016 · W2063825503
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This paper describes a case of deep infiltrating endometriosis in the rectosigmoid that caused ureteral obstruction and subsequent loss of renal function.

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Abstract

UnlabelledEndometriosis is a complex disease with unclear pathogenesis, defined as the presence of endometrial tissue (glands and stroma) outside its usual location in the uterine cavity. Ureteral involvement is rare, with an estimated frequency of 10-14% in cases of deep endometriosis with nodules of 3 cm or larger. An important complication of ureteral involvement is asymptomatic loss of renal function. In a patient with asymptomatic renal failure the relevance of extrinsic ureteral involvement by deep endometriosis has been taken to account.Case reportA 32-year-old nulliparous woman presented with chronic pelvic pain associated with severe dysmenorrhea, dyspareunia and digestive problems including diarrhea, occasional constipation and rectal bleeding. She reported no urological symptoms. Magnetic resonance imaging (MRI) identified a 4 cm nodule in the recto-vaginal septum, compressing and infiltrating the rectal wall, and chronic left hydronephrosis. Isotope renogram revealed 91% function in the right kidney and 9% in the left kidney. A multidisciplinary surgical team including consultants from the departments of digestive surgery and urology assessed the patient. The treatment recommended was a joint approach of laparoscopic surgery to perform adhesiolysis, ureterolysis, freeing of the uterus and appendages, resection of the rectovaginal septum nodule, and left nephrectomy.CommentDiagnosis and treatment of deep endometriosis should be performed in specialized centers and in the context of multidisciplinary collaboration. We must be aware of the potential risk of ureteral involvement and the asymptomatic loss of renal function in any patient with endometriosis nodules of 3 cm or larger.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Renal Insufficiency Ureteral Diseases Adult Endometriosis Endometriosis Endometriosis Female Humans Renal Insufficiency Ureter Ureter Ureteral Diseases Ureteral Diseases Ureteral Diseases

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License: CC0 · commercial use OK