Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7888
Peer-review started: August 22, 2023
First decision: September 19, 2023
Revised: September 21, 2023
Accepted: November 8, 2023
Article in press: November 8, 2023
Published online: November 16, 2023
Processing time: 83 Days and 19.8 Hours
Uterine rupture is a fatal medical complication with a high mortality rate. Most cases of uterine rupture occur in late pregnancy or during labor and are mainly related to uterine scarring due to previous surgical procedures. Adenomyosis is a possible risk factor for uterine rupture. However, spontaneous uterine rupture due to severe adenomyosis in a non-gravida-teenaged female has not been reported in the literature to date.
A 16-year-old girl was referred to our hospital for acute abdominal pain and hypovolemic shock with a blood pressure of 90/50 mmHg. Radiologic studies revealed a huge endometrial mass with multiple nodules in the lung, suggesting lung metastasis. The patient underwent an emergency total hysterectomy and wedge resection of the lung nodules. Histologically, the uterus showed diffuse adenomyosis with glandular and stromal dissociation. Lung nodules were endometrioma with massive hemorrhage. Immunohistochemistry demonstrated that the tumor cells were positive for PAX8, ER, and PR expression, leading to a final diagnosis of pulmonary endometriosis and uterine adenomyosis. Following surgery, the patient remains in good condition without recurrence.
This is the first case of spontaneous uterine rupture due to adenomyosis in a non-gravida adolescent.
Core Tip: Uterine adenomyosis is rare in adolescents but can lead to massive menorrhagia. Differential diagnoses, early detection, and therapeutic care must be provided to avoid hysterectomy in adolescents.