Diagnostic Errors of Nodular Adenomyosis on the Example of a Clinical Case

A. A. Grigoryants, Victor Aksenenko
In: Ural Medical Journal · 2024 · vol. 23(6) , pp. 70–79 · doi:10.52420/umj.23.6.70 · W4405587205
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This clinical case analysis of nodular adenomyosis highlights diagnostic challenges and errors in patients with pelvic pain, emphasizing laparoscopy for diagnosis and treatment.

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This paper analyzes a clinical case of a patient with nodular adenomyosis and a long course of chronic pelvic pain, using review of her medical history, prior examinations, hospitalizations, and treatments, followed by reassessment of available imaging. The authors report diagnostic errors and a resulting chronification of the process, with later re-evaluation of MRI scans leading to suspicion of nodular adenomyosis and subsequent laparoscopy, during which the diagnosis was confirmed; the lesion was removed and an anti-adhesion barrier used. The main limitation is that the evidence is derived from a single clinical case and the paper focuses on retrospective error analysis rather than systematic diagnostic performance. This paper is centrally about endometriosis—Relevance to endometriosis: it discusses chronic pelvic pain and includes literature references on endometriosis mechanisms and diagnosis, though the case and conclusions focus specifically on nodular adenomyosis rather than endometriosis.

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Abstract

Introduction. One of the less common forms of adenomyosis is the nodular type, characterized by localized foci composed of damaged endometrial glands and altered muscle and connective tissue fibers. Diagnosing nodular adenomyosis is oſten challenging, with the diagnosis frequently made intraoperatively or during histological examination. The purpose of the work . To analyze a clinical case involving a patient with nodular adenomyosis and a prolonged history of pelvic pain syndrome, aiming to identify diagnostic errors associated with this condition. Materials and methods. A clinical case was reviewed based on the patient’s medical history and treatments conducted prior to admission to the Gynecology Department of the Stavropol State Medical University Medical Center. Results and discussion . The chronology of diagnosis and treatment, along with an analysis of errors that led to the chronicity of the pathological process and subsequent deterioration in the patient’s quality of life and overall condition, is presented. This clinical case demonstrated that a gynecologist’s primary responsibility when examining patients with pelvic pain syndrome is to conduct detailed diagnostics. The authors re-evaluated the patient’s magnetic resonance imaging scans and suspected the diagnosis of “nodular adenomyosis”, which justified performing laparoscopy to confirm the condition. During the procedure, the diagnosis was confirmed, and the nodular adenomyosis was excised simultaneously. To prevent adhesion formation, an anti-adhesion barrier was applied. Conclusion . Laparoscopy is one of the most critical methods for diagnosing pelvic pain syndrome, as it enables early diagnosis, detailed examination of pelvic and abdominal organs, and the simultaneous execution of therapeutic interventions.
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Ошибки диагностики узлового аденомиоза на примере клинического случая https://doi.org/10.52420/umj.23.6.70 EDN: OEWULV Аннотация Введение. Одной из редко встречающихся форм аденомиоза является узловая. При ней образуются локальные очаги, состоящие из поврежденных желез эндометрия, измененных волокон мышечной и соединительной тканей. Диагностика узловой формы аденомиоза бывает затруднительной, зачастую диагноз ставится лишь интраоперационно или при гистологическом исследовании. Цель работы — проанализировать клинический случай у пациентки с узловой формой аденомиоза и длительным течением синдрома тазовой боли для выявления диагностических ошибок при этом типе заболевания. Материалы и методы. Проанализирован клинический случай на основании истории болезни пациента, включая результаты обследований, госпитализаций и лечения до поступления в отделение гинекологии медицинского центра Ставропольского государственного медицинского университета. Результаты и обсуждение. Приводится хронология диагностики и лечения, анализа ошибок, повлекших за собой хронизацию патологического процесса, как следствие, ухудшение качества жизни и общего состояния пациентки. Разобранный клинический случай показал, что первостепенной задачей акушера-гинеколога при обследовании пациенток с синдромом тазовой боли является детальная диагностика. Авторами произведен пересмотр снимков магнитно-резонансной томографии и заподозрен диагноз «узловой аденомиоз», послуживший основанием для проведения лапароскопии в целях его подтверждения, в ходе которой заболевание подтверждено. Проведено его одномоментное удаление, а для профилактики развития спаечной болезни применен противоспаечный барьер. Заключение. Одним из наиболее значимых методов в диагностике синдрома тазовой боли является лапароскопия, которая помогает поставить диагноз на раннем этапе, провести детальное обследование органов малого таза и брюшной полости и одномоментно выполнить лечебные манипуляции. Об авторах А. А. ГригорьянцРоссия Армен Александрович Григорьянц — кандидат медицинских наук, ассистент кафедры акушерства и гинекологии № 2 Ставрополь Конфликт интересов: Авторы заявляют об отсутствии явных и потенциальных конфликтов интересов. В. А. Аксененко Россия Виктор Алексеевич Аксененко — доктор медицинских наук, профессор, заведующий кафедрой акушерства и гинекологии с курсом дополнительного профессионального образования Ставрополь Конфликт интересов: Авторы заявляют об отсутствии явных и потенциальных конфликтов интересов. Список литературы 1. Sharara FI, Kheil MH, Feki A, Rahman S, Klebanoff JS, Ayoubi JM, et al. Current and prospective treatment of adenomyosis. Journal of Clinical Medicine. 2021;10(15):3410. DOI: https://doi.org/10.3390/jcm10153410. 2. Twiddy H, Bradshaw A, Chawla R, Johnson S, Lane N. Female chronic pelvic pain: the journey to diagnosis and beyond. Pain Management. 2017;7(3):155–159. DOI: https://doi.org/10.2217/pmt-2016-0052. 3. 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Рецензия Для цитирования: Григорьянц АА, Аксененко ВА. Ошибки диагностики узлового аденомиоза на примере клинического случая. Уральский медицинский журнал. 2024;23(6):70–79. https://doi.org/10.52420/umj.23.6.70. EDN: OEWULV For citation: Grigoryants AA, Akseneko VA. Diagnostic Errors of Nodular Adenomyosis on the Example of a Clinical Case. Ural Medical Journal. 2024;23(6):70–79. (In Russ.) https://doi.org/10.52420/umj.23.6.70. EDN: OEWULV JATS XML

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