1402 Hemoperitoneum Caused by Ectopic Location of an Adenomyomatous Polyp

Video Objective To demonstrate an unusual case of hemoperitoneum caused by adenomyomatous polyps growing through the myometrial layer, into the pelvic cavity. Setting An academic teaching hospital. Interventions A 46-year-old woman was referred for postcoital 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, CA-125 elevated to 80.3 U/ml (reference range, 0-35 U/ml) and serum β-hCG level below 1.2mIU/ml. Transvaginal ultrasound demonstrated free fluid in cul-de-sac. The initial clinical diagnosis was hemoperitoneum and she underwent operative laparoscopy. Approximately 500cc of blood and clots were pooled in the abdomino-pelvic cavity. A brown-colored soft lesion with an irregular surface was noted in the right cornua which was suspected to be a ruptured interstitial pregnancy. Removed tissue specimen was sent for frozen biopsy, of which result was endometrial tissue not related to pregnancy. The myometrial lesion showed connection to the endometrial cavity. 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. 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.