Undiagnosed Endometriosis: A Rare Case of Frozen Pelvis
QJ01-QJ02
Correspondence
Dr. Minal A Kalambe,
Assistant Professor, Department of Obstetrics and Gynaecology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Deemed to be University (DU), Nagpur-440022, Maharashtra, India.
E-mail: dr.minalakare@gmail.com
A 40-year-old woman, para two live two, arrived at the emergency room complaining of dysmenorrhoea for three years and postcoital bleeding for four years. She had no previous history of any operation. Her presentation was consistent with acute pain in the abdomen, and she took treatment for that, but it was not relieved. She had no significant family history. Her vital signs, urinalysis, and complete blood count were within normal limits. Her ultrasonography report showed a bilateral ovarian cysts with a 12-week-sized uterus (Table/Fig 1). The differential diagnoses of frozen pelvis included pelvic inflammatory disease, pelvic adhesion disease, recurrent ovarian cysts, leiomyoma, adenomyosis, and hydrosalpinx.
A laparotomy was performed. Upon examination, the uterus was 12 weeks in size, adhered posteriorly to the rectosigmoid colon, and had a right ovarian cyst measuring 6×5 cm and a left ovarian chocolate cyst measuring 4×3 cm (Table/Fig 2). The surgeon requested assistance during the surgery and attempted to remove the adhesion, inadvertently rupturing the wall of the left cyst. The cyst was extracted along with its contents. A salpingo-oophorectomy was conducted after aspirating the left ovarian cyst (chocolate in colour).
Further dissection was not possible due to injury to the bowel and rectosigmoid region. A senior consultant confirmed the diagnosis of a frozen pelvis. The uterus, along with both ovaries, was removed and sent for histopathology, after which the abdomen was closed in layers. The uterus weighed 210 g. The patient had an uneventful postoperative recovery. During follow-up, she received a monthly subcutaneous injection of goserelin 3.5 g. She reported no further complaints of abdominal pain. The histopathology report revealed endometriosis as the cause of the frozen pelvis.