RT Journal Article SR Electronic T1 Rare complication of adenomyosis: acute purulent peritonitis and septicaemia in a young nulligravida JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e238374 DO 10.1136/bcr-2020-238374 VO 14 IS 11 A1 Kameshwarachari Pushpalatha A1 Ruchi Kalra A1 Bharti Singh A1 Anusha Devalla YR 2021 UL http://casereports.bmj.com/content/14/11/e238374.abstract 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.