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Volume 24 |
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Published by : PROFESSIONAL MEDICAL PUBLICATIONS |
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Volume 24 |
January - March 2008 |
Number 1 |
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Adenomyosis uteri in infertile women:
Experience in a Tropical Community Teaching HospitalAdebiyi Gbadebo Adesiyun1, Modupeola Omotara Samaila2, Abimbola Kolawole3
ABSTARCT
Objectives: To determine the demographic pattern and clinical presentation of 23 infertile women with intraoperative diagnosis of adenomyosis followed by histopathologic confirmation.
Methodology: A review of 23 consecutive infertile women that underwent surgery due to preoperative misdiagnosis for uterine fibroids over a period of 5 years.
Results: The patients mean age was 37.3 years with age range of 26 to 47 years. Only five patients (21.7%) had delivered before. Eighteen patients (78.3%) had had abortion(s) in the past. Secondary infertility accounted for 78.3% and 21.7% had primary infertility. Past gynaecological procedures included dilatation and curettage or manual vacuum aspiration in 17 (73.9%) patients, previous adhesiolysis for uterine synaechiae in 3 (13.1%) patients and past history of myomectomy in 5 (21.7%) patients. Preoperative hysterosalpingogram showed only 2 patients (8.7%) with bilateral tubal patency and 17 patients (73.9%) had bilateral tubal blockage. Unilateral patency of the fallopian tube was observed in 4 (17.4%) patients. Amongst patients with bilateral tubal blockage, cornual blockages were mostly encountered in 15 (88.2%) of the 17 patients. The modes of clinical presentation were abdominopelvic mass 100%, dymenorrhoea 82.6%, menorrhagia 60.9%, dyspareunia 47.8% and metrorrhagia in 34.8% of cases. Intraoperatively adenomyosis encountered were diffuse adenomyosis in 13 (56.5%) patients, multiple focal adenomyosis in 7 (30.4%) patients and unifocal adenomyosis in 3 (13.1%) patients. Co-existing uterine fibroid were found in 17 (73.9%) of the 23 patients. Two patients (8.7%) had coexisting endometriosis. At surgery, significant pelvic adhesion was encountered in 7 (30.4%) patients.
Conclusion: In infertile women, adenomyosis is significantly associated with proximal tubal occlusion and tends to co-exist with insignificant uterine fibroids.
KEYWORDS: Adenomyosis, Diagnosis, Infertility.
Pak J Med Sci January - March 2008 Vol. 24 No. 1 38-43
1. Dr. Adebiyi Gbadebo Adesiyun (FWACS),
Department of Obstetrics & Gynaecology,
2. Dr. Modupeola Omotara Samaila (FMCPath),
Department of Pathology,
3. Dr. Abimbola Kolawole (FWACS),
Department of Obstetrics & Gynaecology,
1-3: Ahmadu Bello University Teaching Hospital,
Shika – Zaria, Kaduna State, Nigeria.
Correspondence
Dr. Adebiyi G. Adesiyun,
P.O.Box: 204,
Kaduna - Kaduna State,
Nigeria.
Email: biyi.adesiyun@yahoo.com
* Received for Publication: August 29, 2007
* Accepted: November 3, 2007
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