Acute urinary retention resulting from uterine incarceration due to adenomyosis is a rare occurrence, with limited documented cases. This report details the case of a 38-year-old female presenting with acute urinary retention. Imaging revealed an enlarged retroverted uterus with a mass indicative of adenomyosis, causing direct pressure on the urinary bladder neck. The patient underwent total abdominal hysterectomy, bilateral salpingectomy, and adhesiolysis, resulting in the resolution of symptoms.
Introduction:
Adenomyosis, characterized by the invasion of endometrial tissue into the myometrium, typically presents with symptoms like abnormal uterine bleeding and pelvic pain. While adenomyosis can cause bladder irritation, leading to irritative urinary symptoms, obstructive symptoms such as acute urinary retention are exceptionally rare. This case highlights the unusual presentation of adenomyosis resulting in complete urinary obstruction.
Case Presentation:
A 38-year-old woman presented with one-day history of urinary retention and lower abdominal pain. Imaging confirmed an enlarged uterus due to adenomyosis, obstructing bladder outflow. Surgical intervention was pursued due to the severity of symptoms and patient preference against future pregnancies.
Investigations:
Imaging studies including MRI revealed significant uterine enlargement and anatomical distortion consistent with adenomyosis. Elevated tumor markers were noted, prompting further evaluation for malignancy, which was excluded by histopathology.
Treatment:
Total abdominal hysterectomy with bilateral salpingectomy was performed, addressing the uterine incarceration and resolving urinary obstruction. Post-operative recovery was uneventful, with complete resolution of urinary symptoms.
Discussion:
Adenomyosis causing urinary retention is rare but critical to recognize for prompt management. Differential diagnoses must include gynecological causes of bladder outflow obstruction, necessitating thorough clinical evaluation and imaging.
Conclusion:
This case underscores the importance of considering adenomyosis in the differential diagnosis of acute urinary retention in women. Timely surgical intervention can effectively alleviate symptoms and prevent complications associated with bladder obstruction.
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