Education And Debate

Lesson of the Week: Recurrent pelvic endometriosis and bilateral ureteric obstruction associated with hormone replacement therapy

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7040.1221 (Published 11 May 1996) Cite this as: BMJ 1996;312:1221
  1. R J Brough, research registrara,
  2. K O'Flynn, senior registrara
  1. a Department of Urology, Manchester Royal Infirmary, Manchester M13 9WL
  1. Correspondence to: Mr Brough.
  • Accepted 9 January 1996

Between 2.5% and 15% of women of reproductive age have endometriosis,1 yet the ureter is only rarely affected.2 We report the case of a patient presenting with bilateral ureteric obstruction secondary to recurrent endometriosis. She had previously undergone a total hysterectomy and bilateral salpingo-oophrectomy for endometriosis and had been taking unopposed oestrogen for postmenopausal symptoms in the five years after surgery.

Case report

A 47 year old health care worker was suddenly admitted to hospital; she complained of three months of increasing bilateral loin pain, change in bowel habit, and general malaise. Six years earlier she had had a hysterectomy and bilateral salpingo-oophrectomy for endometriosis. Surgery showed that she had extensive disease in the pelvis with adhesions obliterating the pouch of Douglas. She was given a six month course of danazol because of the likelihood of residual disease. Histological examination of the ovaries and uterus showed extensive endometriosis affecting the peritoneum and both ovaries, with haemorrhagic adhesions throughout the specimen. Hormone replacement therapy in the form of a combined oestrogen and progestogen pill was offered after the course of danazol, but the patient declined.

Two years after surgery she complained …

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