Javier de Santiago García

Complete loss of unilateral renal function secondary to endometriosis: a report of three cases

OBJECTIVES To report the impact that urinary tract endometriosis may have on renal function. Ureteral endometriosis is an uncommon and silent cause of renal injury. It is therefore very important to be highly suspicious in order to be able to make an early diagnosis and thus prevent renal failure. STUDY DESIGN Case reports of the management and outcome of three cases of premenopausal women with deep endometriosis affecting the ureter, associated with secondary unilateral complete loss of renal function. RESULTS AND CONCLUSIONS Ureteral involvement by endometriosis is a rare and often silent disease which is capable of producing significant morbidity, as it can lead to hydronephrosis and ultimately to renal failure. Because of the lack of specific symptoms and the limitations of imaging methods, a high index of suspicion is necessary to obtain an early diagnosis. On diagnosis of deep infiltrating endometriosis, urinary tract ultrasound is a screening tool to detect ureterohydronephrosis due to ureteral obstruction. MRI is of value to map the extent of disease. Surgery is the treatment of choice to remove endometriotic lesions and relieve ureteral obstruction if the kidney is still functional, or to perform a nephrectomy if there is a complete loss of renal function.

Ileocecal endometriosis: diagnosis and management

OBJECTIVE Ileocecal endometriosis is rare. Symptoms range from no symptoms, cramps, vomiting, to acute intestinal obstruction. Our objective was to review our cases, clarify, and resume its most appropriate management focusing on the factors to determine diagnosis. This is a retrospective study by revision of medical charts of all ileal endometriosis cases of our unit from 2006 to 2014. CASE REPORT Seven cases were found; three (43%) had previous endometriosis laparoscopic diagnosis, four (57%) had partial bowel obstruction episodes, three (43%) had chronic pelvic pain, and one developed acute intestinal obstruction in postoperative ileostomy closure. In three (43%), the diagnosis was made with magnetic resonance imaging (MRI) and double contrast barium enema, in one (14%) only with MRI, and the other three (43%) during surgery. All patients underwent resection of the ileum and evolved favorably. CONCLUSION Variability in symptoms hinders diagnosis. The gold standard for diagnosis is MRI, but clinical suspicion optimizes imaging test diagnosis. Segmental resection should be indicated in the majority of the cases.

Mastitis granulomatosa lobulillar idiopática

Resumen Presentamos un caso de mastitis granulomatosa lobulillar idiopatica, entidad benigna infrecuente de la mama, que es importante tener en cuenta en el diagnostico diferencial de los nodulos mamarios por su posible confusion con un proceso neoplasico maligno. El diagnostico pasa por la escision quirurgica y el analisis anatomopatologico de la pieza de biopsia. La actitud terapeutica puede ser diversa.

Sciatic nerve involvement as an unusual presentation of deep endometriosis

Introduction Endometriosis affecting the sciatic nerve is extremely uncommon. Its main symptom is catamenial sciatica but it can result in neuropathy. The diagnosis is usually delayed for years. Our objective is to communicate our experience in the diagnosis, management and treatment of this pathology by presenting two patients. Methods Retrospective revision of medical charts of all sciatic endometriosis cases treated in the Endometriosis Unit of the University Hospital, La Paz, Spain. Results Two nulliparous patients 35 and 39 years old, with unilateral sciatica related to sciatic nerve endometriosis are presented. The lag time between the onset of symptoms and diagnosis was 8 and 5 years. Both patients had problems with locomotion and muscle atrophy, so laparoscopic neurolysis was performed with success in pain control but not total recovery of deambulation defect. Conclusions Directed anamnesis and magnetic resonance imaging (MRI) are good tools for diagnosis of endometriosis affecting sciatic nerve. In absence of neuropathy, hormonal pharmacotherapy can be used to control symptoms, but when it is present, surgical nerve decompression must not be delayed, and laparoscopic approach is feasible for trained surgeons. In our cases, neurolysis improved pain but complete recovery of motor function has not been reached. Physicians responsible for primary care need to be aware of the catamenial sciatica due to the nerve damage caused by endometriosis, even when it is very uncommon, because the consequences of the delay in assessment and treatment by a specialized multidisciplinary team in dedicated units may be irreversible.

Cáncer sincrónico: neoplasias ginecológicas concurrentes de cuello, ovario y trompa. Caso clínico

Tumores ginecologicos primarios dobles sincronicos son relativamente frecuentes. Sin embargo los triple sincronicos son extremadamente raros, mas aun si uno de ellos es un tumor ginecologico extremadamente infrecuente, como es el cancer de la trompa de Fallopio. Presentamos el caso de una mujer de 39 anos con canceres primarios sincronicos del cuello uterino, ovario y trompa de Fallopio. No hay muchos casos descritos en la literatura, y casi todos ellos estan relacionados con la mutacion MSH2 (sindrome de Lynch) o BCRA. Es dificil diagnosticar un cancer sincronico preoperatoriamente y habitualmente son hallazgos despues de cirugia profilactica efectuada en pacientes con historia familiar de cancer.

AFECTACIÓN GANGLIONAR EN PACIENTE CON ENDOMETRIOSIS PROFUNDA RECTOVAGINAL

Se describe un raro caso de endometriosis rectovaginal con compromiso ganglionar en mujer de 33 anos. La presencia de tejido endometrial en ganglios linfaticos pelvicos es rara y ha sido confirmada en la literatura en mujeres que han sido sometidas a cirugia por endometriosis. La presencia de endometriosis en los ganglios linfaticos pelvicos es muy improbable que surja de novo y sugiere extension de la enfermedad.