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A Case of Severe Adenomyosis in a Young Adolescent

Received: 16 June 2021     Accepted: 8 July 2021     Published: 30 October 2021
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Abstract

Adenomyosis refers to a disorder in which endometrial glands are present within the uterine muscle which can be either diffuse or localized that may cause heavy menstrual bleeding, dysmenorrhea, and infertility. The disease usually affects multiparous women. Around 70-80% of the cases are reported in women of age between 40 and 50 years. Very few cases of adenomyosis in young adolescent are reported, and the diagnosis in such case becomes notoriously difficult, but still can be highly suspected with the help of ultrasound (USS) and Magnetic Resonance Imaging (MRI). Here, we present a case of 15-year old girl attending the emergency care with acute abdominal pain. The patient underwent diagnostic laparoscopy which revealed bleeding in the peritoneal cavity and a big hypertrophied uterus. Erosion and active bleeding was observed from the surface of the uterus; the case was advanced to laparotomy. The uterus was uniformly enlarged and boggy that was completely eroded and bled actively. Multiple biopsies were taken from different parts of uterine lesion and sent for frozen section histopathology examination. The blood was sucked from the peritoneal cavity, followed by placement of multiple hemostatic stitches. The results revealed severe adenomyosis. Only very few cases of adenomyosis in adolescents are reported to date and since fertility preservation is considered as an important goal, the traditional treatment of endometriosis may not be applicable to treat adenomyosis in case of young adolescent for fear of jeopardizing the reproductive life. Preserving the fertility in the adolescent and young adult patients poses a major challenge keeping in mind the adequate treatment required without affecting the general health of the patient.

Published in Science Journal of Clinical Medicine (Volume 10, Issue 4)
DOI 10.11648/j.sjcm.20211004.11
Page(s) 85-88
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Adolescent, Adenomyosis, Adenomyoma, Fertility Preservation

References
[1] Naftalin J, Hoo H, N, Holland T, Mavrelos D, et al (2016) Association between ultrasound features of adenomyosisand severity on menstrual pain Ultrasound Obstet Gynecol 47; 779-783.
[2] Tsui KH. Lee WL, Chen CY, Sheu BC, Yen MS, et al (2014) Medical treatment for adenomyosi and/or adenomyoma. Taiwan j Obstet Gynecol 53; 459-465.
[3] Senturk LM, Imamoglu M. Adenomyosis: what is new? Womens Health (Lond). 2015 Aug; 11 (5): 717-24.
[4] Singh S, Best C, Dunn S, Leyland N, Wolfman WL. Society of Obstetricians and Gynaecologists of Canada (SOGC) No. 292-Abnormal Uterine Bleeding in Pre-Menopausal Women. J Obstet Gynaecol Can. 2018 May; 40 (5): e391-e415.
[5] Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am FamPhysician. 2019 Apr 1; 99 (7): 435-443. PubMed PMID: 30932448.
[6] Vidal IS, Soares LS, Dutra CA, Jovino MJ, Gonçalves AK, et al. (2018) Adenomyosis in an 18-Year-Old Adolescent: A Case Report. Obstet Gynecol Cases Rev 5: 121. doi.org/10.23937/2377-9004/1410121.
[7] AboubakrElnashar. Emerging treatment of endometriosis. Middle East Fertility Society. 2015 June 20 (2): 61-69.
[8] Koukoura O, Kapsalaki E, Daponte A, Pistofidis G. Laparoscopic treatment of a large uterine cystic adenomyosis in a young patient. BMJ Case Rep. 2015 Oct; 2015. pii: bcr2015210358. doi: 10.1136/bcr-2015-210358. PubMed PMID: 26430229; PubMed Central PMCID: PMC4600803.
[9] Cucinella G, Billone V, Pitruzzella I, Lo Monte AI, Palumbo VD, Perino A. Adenomyotic cyst in a 25-year-old woman: case report. J Minim Invasive Gynecol. 2013 Nov-Dec; 20 (6): 894-8. doi: 10.1016/j.jmig.2013.04.022. Epub 2013 Jul 10. PubMed PMID: 23849619.
[10] Chun SS, Hong DG, Seong WJ, Choi MH, Lee TH. Juvenile cystic adenomyoma in a 19-year-old woman: a case report with a proposal for new diagnostic criteria. JLaparoendosc Adv Surg Tech A. 2011 Oct; 21 (8): 771-4. doi: 10.1089/lap.2011.0014.Epub 2011 May 11. PubMed PMID: 21561337.
[11] Howard FM. Surgical treatment of endometriosis. Obstet Gynecol Clin North Am. 2011 Dec; 38 (4): 677-86. doi: 10.1016/j.ogc.2011.09.004. Review. PubMed PMID: 22134016.
[12] Oliveira MAP, Raymundo TS, Soares LC, Pereira TRD, Demôro AVE. How to UseCA-125 More Effectively in the Diagnosis of Deep Endometriosis. Biomed Res Int. 2017; 2017: 9857196. doi: 10.1155/2017/9857196. Epub 2017 Jun 4. PubMed PMID: 28660213; PubMed Central PMCID: PMC5474266.
[13] Harmsen MJ, Wong CFC, Mijatovic V, Griffioen AW, Groenman F, Hehenkamp WJK, Huirne JAF. Role of angiogenesis in adenomyosis-associated abnormal uterinbleeding and subfertility: a systematic review. Hum Reprod Update. 2019 Sep 11; 25 (5): 647-671. doi: 10.1093/humupd/dmz024. PubMed PMID: 31504506; PubMedCentral PMCID: PMC6737562.
[14] Słopień R, Męczekalski B. Aromatase inhibitors in the treatment of endometriosis. Prz Menopauzalny. 2016 Mar; 15 (1): 43-7. doi: 10.5114/pm.2016.58773. Epub 2016 Mar 29. Review. PubMed PMID: 27095958; PubMed Central PMCID: PMC4828508.
[15] Kelekci S, Kelekci KH, Yilmaz B. Effects of levonorgestrel-releasingintrauterine system and T380A intrauterine copper device on dysmenorrhea and daysof bleeding in women with and without adenomyosis. Contraception. 2012 Nov; 86 (5): 458-63. doi: 10.1016/j.contraception.2012.04.001. Epub 2012 Jul 24. PubMed PMID: 22832203.
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    Ahmed Abdulwahab Abdulkarim. (2021). A Case of Severe Adenomyosis in a Young Adolescent. Science Journal of Clinical Medicine, 10(4), 85-88. https://doi.org/10.11648/j.sjcm.20211004.11

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    ACS Style

    Ahmed Abdulwahab Abdulkarim. A Case of Severe Adenomyosis in a Young Adolescent. Sci. J. Clin. Med. 2021, 10(4), 85-88. doi: 10.11648/j.sjcm.20211004.11

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    AMA Style

    Ahmed Abdulwahab Abdulkarim. A Case of Severe Adenomyosis in a Young Adolescent. Sci J Clin Med. 2021;10(4):85-88. doi: 10.11648/j.sjcm.20211004.11

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  • @article{10.11648/j.sjcm.20211004.11,
      author = {Ahmed Abdulwahab Abdulkarim},
      title = {A Case of Severe Adenomyosis in a Young Adolescent},
      journal = {Science Journal of Clinical Medicine},
      volume = {10},
      number = {4},
      pages = {85-88},
      doi = {10.11648/j.sjcm.20211004.11},
      url = {https://doi.org/10.11648/j.sjcm.20211004.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20211004.11},
      abstract = {Adenomyosis refers to a disorder in which endometrial glands are present within the uterine muscle which can be either diffuse or localized that may cause heavy menstrual bleeding, dysmenorrhea, and infertility. The disease usually affects multiparous women. Around 70-80% of the cases are reported in women of age between 40 and 50 years. Very few cases of adenomyosis in young adolescent are reported, and the diagnosis in such case becomes notoriously difficult, but still can be highly suspected with the help of ultrasound (USS) and Magnetic Resonance Imaging (MRI). Here, we present a case of 15-year old girl attending the emergency care with acute abdominal pain. The patient underwent diagnostic laparoscopy which revealed bleeding in the peritoneal cavity and a big hypertrophied uterus. Erosion and active bleeding was observed from the surface of the uterus; the case was advanced to laparotomy. The uterus was uniformly enlarged and boggy that was completely eroded and bled actively. Multiple biopsies were taken from different parts of uterine lesion and sent for frozen section histopathology examination. The blood was sucked from the peritoneal cavity, followed by placement of multiple hemostatic stitches. The results revealed severe adenomyosis. Only very few cases of adenomyosis in adolescents are reported to date and since fertility preservation is considered as an important goal, the traditional treatment of endometriosis may not be applicable to treat adenomyosis in case of young adolescent for fear of jeopardizing the reproductive life. Preserving the fertility in the adolescent and young adult patients poses a major challenge keeping in mind the adequate treatment required without affecting the general health of the patient.},
     year = {2021}
    }
    

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    T1  - A Case of Severe Adenomyosis in a Young Adolescent
    AU  - Ahmed Abdulwahab Abdulkarim
    Y1  - 2021/10/30
    PY  - 2021
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    JF  - Science Journal of Clinical Medicine
    JO  - Science Journal of Clinical Medicine
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    EP  - 88
    PB  - Science Publishing Group
    SN  - 2327-2732
    UR  - https://doi.org/10.11648/j.sjcm.20211004.11
    AB  - Adenomyosis refers to a disorder in which endometrial glands are present within the uterine muscle which can be either diffuse or localized that may cause heavy menstrual bleeding, dysmenorrhea, and infertility. The disease usually affects multiparous women. Around 70-80% of the cases are reported in women of age between 40 and 50 years. Very few cases of adenomyosis in young adolescent are reported, and the diagnosis in such case becomes notoriously difficult, but still can be highly suspected with the help of ultrasound (USS) and Magnetic Resonance Imaging (MRI). Here, we present a case of 15-year old girl attending the emergency care with acute abdominal pain. The patient underwent diagnostic laparoscopy which revealed bleeding in the peritoneal cavity and a big hypertrophied uterus. Erosion and active bleeding was observed from the surface of the uterus; the case was advanced to laparotomy. The uterus was uniformly enlarged and boggy that was completely eroded and bled actively. Multiple biopsies were taken from different parts of uterine lesion and sent for frozen section histopathology examination. The blood was sucked from the peritoneal cavity, followed by placement of multiple hemostatic stitches. The results revealed severe adenomyosis. Only very few cases of adenomyosis in adolescents are reported to date and since fertility preservation is considered as an important goal, the traditional treatment of endometriosis may not be applicable to treat adenomyosis in case of young adolescent for fear of jeopardizing the reproductive life. Preserving the fertility in the adolescent and young adult patients poses a major challenge keeping in mind the adequate treatment required without affecting the general health of the patient.
    VL  - 10
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Author Information
  • Obstetric and Gynecology Department, King Saud University, King Saud Medical City, Riaydh, KSA

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