Abstract
INTRODUCTION:This is a rare case of a 25-cm endometrioma in a woman who presented in a hypertensive emergency. The hypertension was believed to be secondary to the mass effect of the endometrioma on renal vasculature.METHODS:A 20-year-old female presented to the ED with diffuse abdominal pain, severe hypertension (190/121), and acute kidney injury (AKI) (Cr 2.4, GFR 38). At presentation, management of hypertension required intravenous hydralazine and adequate pain control. The workup included an abdominal CT that revealed a large 25×18×12-cm cystic mass. The mass was suspected to have a significant mass-effect on adjacent structures that caused bilateral hydroureteronephrosis secondary to distal ureteral compression. Management of this case began with the placement of bilateral nephrostomy tubes to improve renal function. The pelvic mass was removed with a minimally invasive robotic approach. The patient had an uneventful postoperative course with normalization of blood pressure and resolution of the AKI. Pathology confirmed the diagnosis of endometriosis. Prior to the removal of nephrostomy tubes, a nephrostogram was performed, which demonstrated appropriate drainage bilaterally. At 1 year follow-up, the patient was asymptomatic and was able to conceive. This case report was IRB-exempt.CONCLUSION:A multidisciplinary approach to the management of endometriosis is often warranted as it may affect organs outside of the reproductive system. In this case, the etiology of hypertension is believed to be due to mass effect of the cyst on the renal arteries. Low renal perfusion activates the renin-angiotensin-aldosterone system, releasing Angiotensin II and aldosterone, causing systemic vasoconstriction and secondary hypertension. In this case, a minimally invasive approach to remove the mass and ureterolysis resulted in the resolution of the pelvic pain, AKI, and normalization of blood pressure.