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Abstract: Patient’s description: 5 years ago, a slightly increased menstrual flow and mild dysmenorrhea were detected by examination for uterine fibroids. In the past 2 years, increased menstrual flow with increased dysmenorrhea was observed again. Recently, the symptoms of frequent urination and excessive menstruation have worsened, and the uterus was found to be significantly enlarged.
Basic information】Female, 48 years old
Disease Type】Uterine adenomyoma
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Date of consultation】April 2022
Treatment plan】Surgical treatment (total hysterectomy) + drug treatment (cefuroxime sodium for injection, metronidazole injection, tranexamic acid injection)
Treatment period】6 days of hospitalization
Treatment effect】Surgery was successful, good recovery, good treatment effect
I. Initial consultation
The patient reported: 5 years ago, her menstrual flow was slightly more than before and she had mild dysmenorrhea. In early March 2022, she started to have symptoms of frequent urination and excessive menstruation, and was found to have an enlarged uterus, which led to pressure on the bladder and frequent urination. On April 14, 2022, two days after menstruation, the patient visited our outpatient clinic and wanted to have surgery.
II. Treatment history
The vaginal three-dimensional ultrasound showed that the uterus was enlarged and the muscle wall echogenicity was uneven, which was considered as possible adenomyoma, and the uterus was substantially occupied, which was considered as possible fibroid, and the endometrium showed unclear, cervical cyst and pelvic fluid. Preoperatively, we discussed with the patient and suggested total hysterectomy with preservation of bilateral adnexa because the patient had no fertility requirement and the uterus was significantly enlarged with symptoms such as increased menstruation and dysmenorrhea, and the patient agreed to the surgical plan. The patient agreed to the surgical plan. Laparoscopic total hysterectomy was performed under general anesthesia, and intraoperatively, the bilateral fallopian tubes and ovaries were seen to be normal and were preserved. Postoperatively, cefuroxime sodium for injection and metronidazole injection were given as intravenous anti-inflammatory treatment and tranexamic acid injection was given to stop bleeding.
(Vaginal 3D uterine ultrasound)
III. Treatment results
The patient had a smooth surgical procedure and returned to the ward after anesthesia resuscitation with good physical recovery and no specific intraoperative complications and no damage to the peri-uterine organs. After 6 days of hospitalization, the patient’s vital signs were normal, the patient had exhausted and defecated, the small abdominal wound was healing well, the routine blood tests were normal, and the postoperative pathological examination results returned: uterine adenomyoma, uterine fibroids, no malignant lesions were seen, which was clinically consistent, and the patient was discharged. In conclusion, the operation was successful, the patient recovered well and the treatment effect was good.
IV. Notes
We are glad that after treatment, the patient’s symptoms such as heavy menstruation, dysmenorrhea and frequent urination were relieved. Since the pelvic structure has changed after the patient’s total hysterectomy, it is easy to cause pelvic floor dysfunction and organ prolapse. Therefore, the patient is advised to visit the outpatient clinic one month after the operation to evaluate the pelvic floor function and perform pelvic floor rehabilitation as early as possible. In addition, regular follow-up visits to the outpatient clinic are recommended to check the wound healing status. After total hysterectomy, patients are advised to take a full rest for 3 months, avoid premature sexual intercourse, do not exercise strenuously, do not overexert, and pay attention to local hygiene to reduce infection. After hysterectomy, there will be a certain impact on the body and psychology. Patients should adjust their mindset, face the disease correctly, and divert more attention to avoid negative emotions.
V. Personal insight
Uterine adenomyoma occurs mostly in women of childbearing age, and is more common in menstruating women. After the onset of the disease, with the increase of adenomyoma, excessive menstruation, progressive aggravation of dysmenorrhea and other symptoms gradually appear, and it is often accompanied by uterine fibroids. With the enlargement of adenomyoma and uterus, it is easy to press the bladder forward, which leads to urinary frequency and urgency, and press the rectum backward, which leads to constipation.