The first ethanol sclerotherapy of an accessory cavitated ut
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
A 27-year-old woman consulted for an ACUM in the left uterine horn. Her medical history included hysteroscopy-coelioscopy at the age of 19 for pelvic pain refractory to treatment with step 3 analgesics and suspected noncommunicating left hemi-uterus with hematometra on MRI. The hysteroscopy showed that the uterine cavity was normal, with no malformations. Coelioscopy revealed a nodule in the left anterolateral uterine fundus. The tumor was then drained (via a direct, 1 cm incision) but not excised. The release of a chocolate-brown liquid appeared to confirm the diagnosis of cystic adenomyosis. The incision was sutured with a cross-stitch pattern. At the age of 23, the patient became pregnant.

A male newborn (birthweight: 3500 g) was delivered by caesarean section in an indication of mechanical dystocia. Two years later, persistent, repeated, cramp-like pelvic pain prompted the women to consult. Magnetic resonance imaging revealed left lateral fundal adenomyoma (outer diameter: 28 mm; lumen diameter: 10 mm) but no associated adenomyosis. Several treatments were prescribed (a microdose progestogen contraceptive, a norpregnane progestogen contraceptive, a levonorgestrel intrauterine device, dienogest, and step 2 and 3 analgesics) but did not relieve the patient's symptoms. At the age of 27, the woman consulted again because she wished to become pregnant again, despite the recrudescence of very focal pain in the left uterine horn. Pelvic ultrasound revealed a mass (diameter: 28 mm; lumen: 10 mm) in the left uterine horn, some distance from the uterine cavity.

A diagnostic hysteroscopy showed that the uterine cavity was normal and did not communicate with the mass. With the patient's consent, they decided to perform ethanol sclerotherapy in order to (a) avoid another coelioscopy and tumor excision, and (b) enable pregnancy more rapidly. In the operating room and with vaginal ultrasound guidance, we extracted 5 mL of chocolate-brown liquid and then placed 5 mL of 96% alcohol in the cavity for 15 minutes. At the end of the operation, they recovered all the alcohol. The woman was discharged home two hours later. One month after the operation, the woman was asymptomatic. Pelvic ultrasound showed that the ACUM had not recurred. Two months after ethanol sclerotherapy, the woman became pregnant. The pelvic ultrasound results for the left uterine horn were normal. During the subsequent cesarean delivery (indicated for prolonged pregnancy, labor failure, and uterine scarring), no nodule in the left uterine horn was noted. At a follow-up consultation with the patient at the age of 29, a pelvic ultrasound assessment showed that the ACUM had not recurred.

1 share