Surgical Excision of Endometriosis in the Setting of a Congenital Pelvic Kidney

Abstract

Study Objective To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Design Video of case-presentation. Setting Academic hospital. Patients or Participants Single surgical patient. Interventions Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. Measurements and Main Results A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. Conclusion A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement. To demonstrate the surgical technique and anatomic consideration for excision of endometriosis in the setting of congenital pelvic kidney and demonstrate surgical technique for excision of appendiceal endometriosis. Video of case-presentation. Academic hospital. Single surgical patient. Surgical technique used for excision of endometriosis, requiring bilateral ureterolysis and appendectomy. A 37-year-old G2P1012 woman presented with a history of chronic right lower quadrant pelvic pain, dysmenorrhea, and abnormal uterine bleeding. Her history was notable for recurrent urinary tract infections, nephrolithiasis, and known congenital malrotation of bilateral kidneys and a left congenital pelvic kidney. Prior surgical history significant for diagnostic laparoscopy with ablation of suspected endometriosis. Patient had trialed and failed multiple medical therapies. Congenital pelvic kidney was noted to be in close proximity to left adnexa on transvaginal ultrasound. Give her history of a pelvic kidney, a preoperative CT urogram was ordered to evaluate location of kidneys and ureters, as well as associated vasculature. Given completion of childbearing and desire for surgical management, she was consented for total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. Intraoperatively she was found to have extensive endometriosis with multiple lesions noted throughout the pelvis, including the perinephric peritoneum overlying the left pelvic kidney and left ureter, requiring bilateral ureterolysis. An appendectomy was also performed due to endometriosis overlying the appendix, cecum and surrounding pericolic adipose tissue. The entire procedure was performed laparoscopically and without complication. Histopathology confirmed final diagnosis of endometriosis of all submitted specimens, including the appendix. Patient with routine postoperative course, but notable for significant improvement of pelvic pain and a restored quality of life. A congenital pelvic kidney is uncommon and requires knowledge of aberrant pelvic anatomy prior to surgical dissection of retroperitoneal spaces. Excision of endometriosis reduces symptom recurrence and an appendectomy should be performed when there is appendiceal involvement.