1568 A Case of an Adenomyomatous Polyp Penetrating Uterine Wall into Pelvic Cavity

Study Objective To demonstrate an unusual case of hemoperitoneum caused by adenomyomatous polyps growing through the myometrial layer, into the pelvic cavity. Design Case report. Setting Academic teaching hospital. Patients or Participants A 46-year-old woman was referred for abdominal pain for 3 days. Physical examination revealed both direct and rebound tenderness of the whole abdomen. Her vital signs were stable. The hemoglobin level was 12.7g/dL. Transvaginal ultrasound demonstrated free fluid in cul-de-sac. Interventions The initial clinical diagnosis was hemoperitoneum and she underwent operative laparoscopy. Approximately 500cc of blood and blood clots were pooled in the abdomino-pelvic cavity. A brown-colored soft lesion with irregular surface was removed and specimen was sent for frozen biopsy, of which result was endometrial tissue. The site of removal was closed with interrupted polyglactin endosutures. The postoperative course was uneventful and the final pathologic report was an adenomyomatous polyp. Because the myometrial lesion showed connection to the endometrial cavity, hysteroscopic examination was performed after recovery, demonstrated a polypoid mass and a uterine septum. Hysteroscopic polypectomy was performed and the pathological diagnosis was also an adenomyomatous polyp. Measurements and Main Results The operative time of laparoscopy was 55 minutes with blood loss of about 50 mL. The patient recovered well and was discharged 5 days after the procedure. The operative time of hysteroscopy was 10 mintues. The patient recovered well and was discharged 1 day after the procedure. A transvaginal ultrasound was performed 5 month after hysteroscopic surgery showing no abnormal finding at the site of operation. Conclusion To our knowledge, this is the first report of an adenomyomatous polyp growing through the myometrial layer, into the pelvic cavity. Further study and a larger number of cases are needed to elucidate the mechanism which lies beneath the penetrating growth pattern of the adenomyomatous polyp into the myometrium.