A Bicornuate Uterus with a Unilateral Focal Adenomyosis: A Case Report.

BACKGROUND

The etiology of adenomyosis remains uncertain, and factors such as pregnancy, postpartum endometritis, cesarean delivery, uterine surgery, and uterine trauma are suspected to cause myometrial disruption that may trigger smooth muscle hyperplasia.

CASE: We present a case of a bicornuate uterus with focal adenomyosis confined to the left hemiuterus in a 43-year-old woman who experienced chronic pelvic pain, severe progressive dysmenorrhea, and secondary infertility for three years. She had previously been diagnosed with a bicornuate uterus during two cesarean sections and had a history of curettage, both of which may have contributed to the localized pathology. After thorough counseling regarding management options, a laparotomy total abdominal hysterectomy was performed primarily for pain relief. The postoperative course was uneventful, and the patient was discharged on the third day with complete resolution of pelvic pain, reporting a visual analogue score of 0/10 at follow-up.

DISCUSSION: Previous caesarean sections and curettage are possible in cases of a bicornuate uterus with adenomyosis pathology of hemiuterus. Pain caused by adenomyosis can be managed with laparotomy total abdominal hysterectomy as a gold standard management.