Cystic Adenomyoma simulates uterine malformation: A diagnostic dilemma: Case report of two unusual cases
A 19-year-old unmarried girl presented to us with the complaint of severe dysmenorrhea and menorrhagia for last three months; refractory to any medication. The pain was colicky in nature associated with menstruation and so severe in intensity that incapacitates her routine activities. The pain was not associated with gastrointestinal or urinary symptoms. At consultation in other hospital, she was treated with Oral contraceptive pills (OCP's) and Non steroidal anti-inflammatory drugs (NSAID's); but not relieved. On transabdominal ultrasonography, she was diagnosed as the case of uterine bicornis with a hematometra in obstructed rudimentary horn []. Even MRI findings were suggestive of uterine bicornis with right horn hematometra []. With these findings, patient was referred to our laparoscopy center and laparoscopy was performed on her. A primary umbilical 12 mm port and three 5 mm ancillary ports were created. On inserting the laparoscope; uterus was found to be enlarged asymmetrically, marked globular on left anterior wall, below the cornual end, near attachment of round ligament. No other uterine horn could be seen. Bilateral fallopian tubes and ovaries were normal in appearance. On hysteroscopy, uterine cavity was normal sized and bilateral ostia were seen normally. Diluted vasopressin was injected into the swelling []. A transverse incision was given on anterior uterine surface over the swelling with the harmonic scalpel. When the incision reached the cystic cavity, thick chocolate material was drained [] and endometriotic cyst lining was removed with the harmonic scalpel []. There was no direct communication between the uterine cavity and cyst. Uterine cavity was not entered. The defect was closed meticulously with vicryl 1-0 in three layers [].\nThere were no intraoperative or postoperative complications. The patient was discharged next day after surgery. Postoperatively, GnRH agonist treatment was extended for 2 months. When the menstrual cycle returned, the patient did not experience dysmenorrhea.