Surgical management of adenomyoma with hysteroscopy and laparotomy

Abstract

A nulliparous woman presented with menorrhagia, anemia, and an enlarged uterus. A diagnosis of leiomyoma was made. At surgery, hysteroscopic resection was not possible because of the size of the mass. Laparotomy was performed and the uterus was opened through a "classical incision". Hemostasis was secured with an intrauterine balloon. Histology revealed the mass to be an adenomyoma. Resecting an adenomyoma from the uterus can be complicated. Techniques, such as hysteroscopic examination before laparotomy, using a classical uterine scar, intrauterine balloon, and preoperative gonadotropin-releasing hormone analog may help to minimize the risks.

Current Trends of Alternatives to Hysterectomy in Adenomyosis: A Review Article

“…Hysteroscopic management of adenomyoma is not a first-line treatment option for symptomatic adenomyosis, but it does offer the advantage of direct visualization of the uterine cavity, reducing the amount of distortion caused by the adenomyoma. The diagnosis of adenomyoma can be made through the observation of irregular thickening of the endometrium with tiny openings, hypervascularization, a "strawberry" pattern of the endometrium, a fibrocystic appearance of the endometrium, and a hemorrhagic cyst in the form of dark blue or chocolate brown deposits 15,16 . Hysteroscopic biopsy can also be performed to obtain a histopathological examination of the tissue.…”

Adenomyoma and Hysteroscopy

“…Access is gained to intramural cystic lesions. Treatment by resection or bipolar coagulation can be performed [6].…”

“…Fig.16 6. Hysteroscopic image of cystic adenomyotic lesion at the fundus of uterus affected by diffuse adenomyosis (diagnosis was confirmed at histological exam on target-eye biopsies), after incision with bipolar electrodes.…”