Extensive iatrogenic adenomyosis after laparoscópic myomectomy

Adam Ostrzenski, A Ostrzenski, Ostrzenski A
Fertility and sterility · 1998 · vol. 69(1) , pp. 143–145 · doi:10.1016/s0015-0282(97)00431-7 · PMID:9457951 · W1964583352
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This paper examines the occurrence of extensive iatrogenic adenomyosis following laparoscopic myomectomy.

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Abstract

ObjectiveTo report a case of iatrogenic adenomyosis as a result of not reconstructing the uterine wall during a laparoscopic myomectomy.DesignRetrospective case report.SettingUniversity hospital.Patient(s)A 34-year-old woman, gravida O, had been referred to our institution for medical care. A laparoscopic penetrating leiomyomata uteri was removed 8 months before this hospital admission. Approximately 3 months after the initial laparoscopic myomectomy, she began experiencing pelvic pain in the middle low abdominal area, more accentuated in the second phase of the menstrual cycle, with peak pain during menstruation. The pain became progressively worse. Microcytic-hypochromic anemia secondary to menorrhagia was documented. Flexible office hysteroscopy, contrast ultrasonography, and magnetic resonance imaging (MRI) results suggested the presence of focal adenomyosis.Intervention(s)Eight months after the initial laparoscopic myomectomy, the patient underwent a second-look laparoscopy to excise the visual uterine wall defect and reconstruct laparoscopically the layers of the uterine wall.Main outcome measure(s)Uterine wall histopathology and menstrual history.Result(s)Resolution of patient's pain, resumption of normal menses, and secondary anemia was ameliorated.Conclusion(s)Suturing the myometrium in layers during a laparoscopic myomectomy is necessary to prevent iatrogenic adenomyosis.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Iatrogenic Disease Laparoscopy Adult Endometriosis Endometriosis Endometriosis Female Humans Laparoscopy Leiomyoma Leiomyoma Reoperation Retrospective Studies Treatment Outcome Uterine Neoplasms Uterine Neoplasms

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License: CC0 · commercial use OK