English

Abstract

Intrauterine adhesions develop as a result of varying degrees of intrauterine trauma. The extent of intrauterine adhesion formation and the impact of the adhesions on the contour of the uterine cavity vary widely. Extensive intrauterine adhesions with amenorrhea and hematometra can develop following endometrial ablation. Thirty one year old parous lady with history of thermal endometrial ablation for menorrhagia presented with complaints of amenorrhea and pain abdomen for two years. Hormonal assays were normal. Transvaginal scan showed absent endometrial stripe with patchy fluid collections in cavity suggestive of adhesions. The findings were corroborated by sonohysterogram and MRI pelvis. Patient did not respond to gonadotrophins. In view of persistent symptoms she was counseled for adhesiolysis under hysteroscopic guidance. Patient opted for hysterectomy. An atrophic uterus was noted intraoperatively and cut section revealed obliterated cavity with adhesive bands and mucoid collections supporting the diagnosis which was later confirmed on histopathological evaluation Extensive intrauterine adhesions with amenorrhea and hematometra can develop following endometrial ablation. Hysteroscopic adhesiolysis with cervical dilatation is the treatment of choice, but hysterectomy can be beneficial in a small subset of patients. INTRODUCTION: Amenorrhea due to intrauterine adhesions was defined by Asherman in 1948 and is often referred to as Asherman's syndrome1. This syndrome results from acquired scarring of the endometrial lining, which prevents the normal build-up and shedding of the endometrium, leading to hypomenorrhoea or even amenorrhea. We are presenting a rare case of Asherman’s syndrome which developed following non resectoscopic thermal ablation of the endometrium. CASE REPORT: Mrs. X 31 year old multiparous lady (para 2, live 2 with previous two LSCS with tubal sterilization done) presented with complaints of amenorrhea and lower abdominal pain for the last two years. She had history of menorrhagia three years back and underwent thermal ablation of endometrium two years back in an outside hospital. She had been amenorrhoeic from then on and started to have lower abdominal pain which was cyclical initially and later progressed to continuous dull aching pain. She had two caesarean sections done ten years and four years back respectively. General examination was unremarkable. Abdomen was soft and cervix appeared healthy. Bimanual pelvic examination showed retroverted normal sized uterus with tenderness in adnexae. Baseline investigations were normal (hemogram, thyroid profile and serum prolactin). Serum FSH was 7.04 mIU/ml; Serum LH was 11.95 mIU/ml and serum estradiol was 44.59 pg/ml. Transvaginal scan of pelvis showed uterus of size 7.7 cm x3.8 cm. Endometrial stripe could not be visualized, with patchy collections of fluid measuring 8x4mm and 8x3mm in the cavity. Both ovaries were normal (Fig. 1). DOI: 10.14260/jemds/2014/2125