Florid endometriosis in a postmenopausal woman.
OBJECTIVE
To report a case of florid endometriosis.


METHODS
Case report.


METHODS
University hospital.


METHODS
A 53-year-old postmenopausal woman with a 10-cm retroperitoneal mass comprised of endometriosis causing hydroureteronephrosis and loss of ipsilateral kidney function.


METHODS
The patient underwent exploratory laparotomy with extensive lysis of adhesions, right nephrectomy, radical resection of the retroperitoneal mass including partial resection of the psoas muscle, dissection from the inferior vena cava, and resection of distal ileum, cecum, and appendix with a primary ileoascending colon reanastomosis.


METHODS
Postoperative symptom resolution.


RESULTS
The patient had widespread adhesive disease with a primary retroperitoneal endometriotic mass and a secondary mass involving the small bowel mesentery. Endometriomas were found in the right kidney and right distal ureter. Additional endometriotic implants were found at the right common iliac bifurcation, appendix, and in multiple mesenteric nodules. No residual ovarian tissue was identified, and preoperative FSH and estrogen (E) levels indicated no evidence of an ovarian remnant.


CONCLUSIONS
Severe endometriosis caused ipsilateral renal failure despite postmenopausal levels of E and FSH, supporting the theory that endometriotic implants may have an autocrine function involving E biosynthesis or may respond to hormone production in adipose tissue.
Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA 22903, USA. AmeliaBailey@virginia.edu
Amelia P
AP
Bailey
Amy K
AK
Schutt
Susan C
SC
Modesitt
D002432:Cecum / Q000473:pathology / Q000601:surgery; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D009401:Nephrosis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D017698:Postmenopause / Q000502:physiology; D016658:Psoas Muscles / Q000473:pathology / Q000601:surgery; D012187:Retroperitoneal Space / Q000473:pathology / Q000601:surgery