OP08.06: Tumour rupture and partial gut obstruction: atypical presentations in a patient with adenomyosis

We are presented with a 49-year-old, Gravida 8 Para 8 (8007), who came in due to vomiting and enlarging abdominal mass. Initial diagnosis was partial gut obstruction and acute kidney injury probably secondary to adenomyosis vs colonic pathology. On ultrasound, she was diagnosed with adenomyosis; however, on computed tomography scan it showed a uterine mass with possible contained tumour rupture and mass effects. She then underwent emergency hysterectomy and complete surgical staging. Intra-operatively, there was an ill-defined endometrial mass with multiple areas of rupture and was diagnosed as malignant. However, the final histopathology revealed extensive adenomyosis with acute inflammation and necrosis, no definite malignancy was identified. Although pelvic pain, AUB and uterine enlargement are the usual manifestations of adenomyosis, other atypical presentations such as uterine rupture and compressive mass effects that may also be present, as was seen in this case. Ultrasound was a useful tool in the pre-operative planning of this case, however it has its pitfalls too as the uterine rupture was not seen. MRI would have been an adjunct imaging modality for this case as CT scan may be unable to distinguish an adenomyotic foci from the normal myometrium. Histopathology remains to be the gold standard in diagnosing adenomyosis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.