Abdominal #4 – Long case

27-year-old female:
* No previous history
* Presents with acute kidney insufficiency
* DD glomerulonephritis
* Nephrotic syndrome
* US to exclide post-renal obstruction

US: Bilateral hydronephrosis and hydro-ureter. No obstructing mass or stone visible. Bilateral loss of parenchyma, indicating chronic problem.Mobile bladder stone.

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Patient receives bilateral nephrostomy. On antegrade pyelography no calibre changes or strictures, not proximal or distal. No cause for hydrnephrosis and hydro-ureter bilateral.

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Non-enhanced abdominal CT to evaluate nephrolithiasis. Traction on sigmoid, coecum and small bowel, andalso traction on bladder roof. Consider endometriosis in the differential diagnosis and perform MRI pelvis.

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MRI pelvis. Medialised adnexes. T2 hypo-intense fibrotic plaque centered on uterus very suggestive for deep invasive endometriosis (DIE). Fibrotic changes between uterus and rectum, uterus and bladder and uterus and bowels. No endometrioma cysts. Central in fibrotic area small aircollection with fistula towards anterior fornix (not completely shown here), with small abscess on major labia.

What is the most likely diagnosis?

Diagnosis: Endometriosis

2 thoughts on “Abdominal #4 – Long case

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