PT  - JOURNAL ARTICLE
AU  - Kameshwarachari Pushpalatha
AU  - Ruchi Kalra
AU  - Bharti Singh
AU  - Anusha Devalla
TI  - Rare complication of adenomyosis: acute purulent peritonitis and septicaemia in a young nulligravida
AID  - 10.1136/bcr-2020-238374
DP  - 2021 Nov 01
TA  - BMJ Case Reports
PG  - e238374
VI  - 14
IP  - 11
4099  - http://casereports.bmj.com/content/14/11/e238374.short
4100  - http://casereports.bmj.com/content/14/11/e238374.full
SO  - BMJ Case Reports2021 Nov 01; 14
AB  - Adenomyosis is a benign gynaecological condition in multiparous women during their middle age commonly presenting as pelvic pain and menorrhagia. We report a case of a 27-year-old nulligravida of Asian origin from the Indian subcontinent who presented with a huge adenomyotic uterus with mild splenomegaly, and portal cavernoma having gross ascites that developed life-threatening peritonitis and septicaemia. Endometrial aspiration done showed no atypia or malignancy and upper gastrointestinal tract endoscopy done showed no dilated varices. With increasing abdominal distension, she developed tachycardia, tachypnoea, septicaemia and oliguria. Exploratory laparotomy done revealed purulent loculi, omentum and bowel adhesion around the uterus. Adnexa was not distinctly identifiable. Hysterectomy with left salpingo-oopherectomy was performed. She required ventilatory support and intensive unit care postoperatively. Histopathology examination showed adenomyosis with suppuration, right ovary endometriotic cyst and left ovary non-specific inflammation. The patient was discharged in stable condition on day 21. Adenomyosis may rarely occur in young nulligravida women as life-threatening manifestations with purulent peritonitis and septicaemia. Early exploration is crucial for diagnosis and recovery.