Diagnosis: Ureteral Endometriosis arising from Large DIE Recto-vaginal space with infiltration of parametrium, ureter and vaginal fornix.
Operation: Laparoscopic Ureterolysis, resection of DIE nodule and partial vaginectomy.
Pertinent Medical History: 27 years old G:0, P:0 Virgin with h/o pelvic pain since age if 16 was referred with diagnosis of ureteral stricture caused by endometriosis after cystoscopy and insertion of double J catheter by urologist.
Pelvic Ultrasound: Uterine size: 87x49x31 mm with normal ovaries, right kidney:116x44mm, left kidney: 124×53 mm with sever hydronephrosis and ureteral dilatation.
MRI: Irregular mass like lesion 35x20x25mm in Retro-Cervical area involving rectal serosa and bilateral uterosacral ligaments, this involvement is more prominent in left side which shows enhancement after administration of contrast media suggestive of DIE.
CA-125 =115 CA-19-9 =28.8 AMH =7.6