INTRODUCTION: Case presentation of a 32-year-old G0 female with severe dysmenorrhea for over 20 years who progressed to left-sided chronic pelvic pain who presents for evaluation at our clinics. Previously nonresponsive to hormonal treatment. She underwent surgical management for a mass suspected priorly to be a fibroid, yet upon analysis of the tissue after resection, it was found to be an adenomyoma. OBJECTIVE: To outline the surgical approach in a 32-year-old patient with chronic pelvic pain and imaging findings of a uterine mass. We demonstrate the surgical steps used to excise a uterine mass, later confirmed as a true adenomyoma, via a minimally invasive approach. Additionally, we present the patient’s experience with chronic pain before and after surgery. METHODS: Laparoscopic resection of an adenomyoma. The procedure began with a bladder flap creation, followed by releasing adhesions along the white line of Toldt. Retroperitoneal dissection was performed to identify the left ureter. The uterine artery was traced and isolated, and dilute vasopressin was injected at the site of the mass. The serosa was dissected, and the mass was resected using ultrasonic energy with traction and countertraction. The uterus was reconstructed, and endometriotic implants were excised for symptom management. RESULTS: At 2 months post-op, the patient reported significant improvement, no longer experiencing nausea, vomiting, chills, or fever during menses. Mild pain during ovulation and menstruation was managed with OTC medications. CONCLUSIONS: Adenomyomas, often classified under focal adenomyosis, warrant greater recognition. Proper identification and treatment are essential, as they typically cause more pain than myomas. This case highlights significant pain reduction following surgical excision.
Mazo et al. (Fri,) studied this question.