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Extensive iatrogenic adenomyosis after laparoscopic myomectomy
1Department of Gynecology and Obstetrics, Howard University College of Medicine and Howard University Hospital, Washington, DC, USA. ostrzenski@newsurgery.com
Objective:
To report a case of iatrogenic adenomyosis as a result of not reconstructing the uterine wall during a laparoscopic myomectomy.
Design:
Retrospective case report.
Setting:
University 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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