Obstetrics and Gynaecology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India.
Obstetrics and Gynaecology, All India Institute of Medical Science, Bhopal, Madhya Pradesh, India
BMJ Case Rep. 2021 Nov 29;14(11):e238374. doi: 10.1136/bcr-2020-238374.
Adenomyosis is a benign gynaecological condition in multiparous women during their middle age commonly presenting as pelvic pain and menorrhagia. We report a case of a 27-year-old nulligravida of Asian origin from the Indian subcontinent who presented with a huge adenomyotic uterus with mild splenomegaly, and portal cavernoma having gross ascites that developed life-threatening peritonitis and septicaemia. Endometrial aspiration done showed no atypia or malignancy and upper gastrointestinal tract endoscopy done showed no dilated varices. With increasing abdominal distension, she developed tachycardia, tachypnoea, septicaemia and oliguria. Exploratory laparotomy done revealed purulent loculi, omentum and bowel adhesion around the uterus. Adnexa was not distinctly identifiable. Hysterectomy with left salpingo-oopherectomy was performed. She required ventilatory support and intensive unit care postoperatively. Histopathology examination showed adenomyosis with suppuration, right ovary endometriotic cyst and left ovary non-specific inflammation. The patient was discharged in stable condition on day 21. Adenomyosis may rarely occur in young nulligravida women as life-threatening manifestations with purulent peritonitis and septicaemia. Early exploration is crucial for diagnosis and recovery.
子宫腺肌病是一种多发于中年多产妇的良性妇科疾病，常表现为盆腔疼痛和月经过多。我们报告了一例来自印度次大陆的 27 岁、未生育的亚洲裔患者，她患有巨大的子宫腺肌病，伴有轻度脾肿大和门静脉海绵样变性导致的大量腹水，发展为危及生命的腹膜炎和败血症。子宫内膜抽吸术未见不典型或恶性病变，上消化道内镜检查未见扩张的静脉曲张。随着腹部膨隆的增加，她出现心动过速、呼吸急促、败血症和少尿。剖腹探查显示子宫周围有脓性小腔、大网膜和肠粘连。附件无法明确识别。行子宫切除术和左侧输卵管卵巢切除术。术后需要通气支持和重症监护。组织病理学检查显示化脓性子宫腺肌病、右侧卵巢子宫内膜异位囊肿和左侧卵巢非特异性炎症。患者在第 21 天稳定出院。子宫腺肌病在年轻未生育的妇女中罕见，可出现危及生命的化脓性腹膜炎和败血症表现。早期探查对诊断和恢复至关重要。
