Document Detail

Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis.
MedLine Citation:
PMID:  17197355     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To present a case of hydronephrosis and hydroureter secondary to pelvic endometriosis and to discuss the pitfalls in laparoscopic management. CASE REPORT: A 37-year-old nulligravida woman had mild elevation of blood pressure for about 1 year without abdominal pain, dyspareunia, or dysmenorrhea. Renal ultrasound revealed left hydronephrosis and a 4-cm pelvic cyst. Intravenous pyelogram showed distal ureteral obstruction. An MRI with fat saturation disclosed a left ovarian endometrioma and a lesion in the uterosacral ligament causing periureteral compression. Laparoscopic findings included a dilated left ureter above the uterosacral ligament, left uterosacral ligament endometriosis with adhesions, and a 4-cm left ovarian endometrioma. Cystoureteroscopy showed external ureteral compression 2 cm above the ureteral orifice. A ureteral catheter was placed. The left endometrioma was enucleated and ureterolysis was performed. The latter procedure had to be discontinued because of bleeding from descending uterine vessels. The ureteral catheter was removed 2 months later and her blood pressure gradually returned to normal. However, after 1 year, she was found to have recurrent hydronephrosis and underwent segmental resection of the distal ureter and reconstruction by end-to-end reanastomosis. CONCLUSION: In women of reproductive age, hydronephrosis and hypertension may be the only symptoms of endometriosis. While laparoscopic treatment is useful in endometriosis, it may fail in the presence of chronic inflammation and severe fibrosis.
Hsing-Yu Chen; Ming-Chao Huang; Yu-Chung Hung; Yung-Hsuen Hsu
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Taiwanese journal of obstetrics & gynecology     Volume:  45     ISSN:  1875-6263     ISO Abbreviation:  -     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2007-01-01     Completed Date:  2007-01-26     Revised Date:  2007-12-28    
Medline Journal Info:
Nlm Unique ID:  101213819     Medline TA:  Taiwan J Obstet Gynecol     Country:  China    
Other Details:
Languages:  eng     Pagination:  142-5     Citation Subset:  IM    
Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.
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MeSH Terms
Adnexal Diseases / complications*,  diagnosis,  surgery*
Endometriosis / complications*,  diagnosis,  surgery*
Hydronephrosis / etiology,  radiography
Magnetic Resonance Imaging
Reconstructive Surgical Procedures
Treatment Failure
Ureter / surgery
Ureteral Obstruction / diagnosis,  etiology*,  surgery*

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