Hunjan Tia, Davidson Andrew
Department of Obstetrics & Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
City Fertility Clinic, Robina, Queensland, Australia.
BMJ Case Rep. 2015 Feb 27;2015:bcr2014209012. doi: 10.1136/bcr-2014-209012.
A 38-year-old nulliparous female presented to an assisted conception clinic with subfertility and a long-standing history of dysmenorrhoea. Transvaginal ultrasound revealed two lesions in the body of the uterus, which were presumed to be fibroids. A decision was made to remove these lesions prior to attempting in vitro fertilisation (IVF). However, on laparotomy, deeply penetrating adenomyosis was discovered, resulting in an unexpected hysterectomy and significant blood loss. Based on our experience, we highlight the importance of suspecting a diagnosis of adenomyosis preoperatively and the methods by which this diagnosis can be made, in order to avoid potential unforeseen outcomes as described in this case. We discuss conservative management options for this condition, particularly in women wishing to preserve fertility.
一名38岁未生育的女性因生育力低下和长期痛经前往一家辅助生殖诊所就诊。经阴道超声检查发现子宫体有两个病变，推测为子宫肌瘤。决定在尝试体外受精（IVF）之前切除这些病变。然而，在剖腹手术中，发现了深部浸润性子宫腺肌病，导致意外的子宫切除术和大量失血。根据我们的经验，我们强调术前怀疑子宫腺肌病诊断的重要性以及做出该诊断的方法，以避免本病例中所述的潜在意外后果。我们讨论了这种情况的保守治疗选择，特别是对于希望保留生育能力的女性。
