A Case of Severe Adenomyosis in a Young Adolescent

Adenomyosis refers to a disorder in which endometrial glands are present within the uterine muscle which can be either diffuse or localized that may cause heavy menstrual bleeding, dysmenorrhea, and infertility. The disease usually affects multiparous women. Around 70-80% of the cases are reported in women of age between 40 and 50 years. Very few cases of adenomyosis in young adolescent are reported, and the diagnosis in such case becomes notoriously difficult, but still can be highly suspected with the help of ultrasound (USS) and Magnetic Resonance Imaging (MRI). Here, we present a case of 15-year old girl attending the emergency care with acute abdominal pain. The patient underwent diagnostic laparoscopy which revealed bleeding in the peritoneal cavity and a big hypertrophied uterus. Erosion and active bleeding was observed from the surface of the uterus; the case was advanced to laparotomy. The uterus was uniformly enlarged and boggy that was completely eroded and bled actively. Multiple biopsies were taken from different parts of uterine lesion and sent for frozen section histopathology examination. The blood was sucked from the peritoneal cavity, followed by placement of multiple hemostatic stitches. The results revealed severe adenomyosis. Only very few cases of adenomyosis in adolescents are reported to date and since fertility preservation is considered as an important goal, the traditional treatment of endometriosis may not be applicable to treat adenomyosis in case of young adolescent for fear of jeopardizing the reproductive life. Preserving the fertility in the adolescent and young adult patients poses a major challenge keeping in mind the adequate treatment required without affecting the general health of the patient.