A case of cystic adenomyosis combined with severe intrauterine adhesions misdiagnosed as Robert's uterine malformation and literature review
Objective To analyze a rare case of cystic adenomyosis complicated combined with severe intrauterine adhesions misdiagnosed as Robert's uterine malformation,and to summarize and analyze the causes of misdiagnosis and preventive measures for misdiagnosis.Methods The clinical data,diagnosis and treatment process of a case of cystic adenomyosis misdiagnosed as Robert's uterine malformation admitted to Hubei Maternal and Child Health Care Hospital in February 2022 were retrospectively analyzed.Results The patient was presented with "medically uncontrollable dysmenorrhea".Color ultrasound and magnetic resonance(MR)with/without contrast of the uterine adnexa showed that Robert's uterus was malformed.After admission,laparoscopy and hysteroscopic hysterectomy were performed.Under laparoscopy,the transverse diameter of the uterine fundus was widened,the right uterine angle was full,and the right middle and distal fallopian tubes were significantly enlarged.The right uterine horn and fallopian tube opening could not be exposed after repeated electrotomy by plasma bipolar electroknife under hysteroscope.Postoperative histological findings showed that the uterine corner lesions were hyperplasia of endometrium and smooth muscle tissue.Combined with the intraoperative findings,the patient's surgical history and postoperative pathological examination,the final diagnosis of uterine cornual cystic adenomyosis combined with intrauterine adhesions was confirmed.Three cycles of gonadotropin-releasing hormone agonist(GnRH-a)combined with intrauterine implantation of mirena ring were administered for long-term management.After 6 months of follow-up,the patient had a good prognosis and no recurrence of the lesions.Conclusions For refractory dysmenorrhea,it is necessary to distinguish whether it is primary or secondary,and the diagnosis cannot be made only based on imaging examination.Especially when evaluating whether the patient has uterine malformation,preoperative systematic consultation and complete auxiliary examination are particularly important to avoid inappropriate diagnosis and treatment.
NETL
NSTL
万方数据
维普
