A Rare Case of Asherman's Syndrome after Open Myomectorny: Sonographic Investigations and Possible Underlying Mechanisms

作者：Papoutsis Dimitrios^*; Georgantzis Dimitrios; Dacco Maria Diletta; Halmos Gabor; Moustafa Mohsen; Pinto Ana Rita Mesquita; Magos Adam

来源：Gynecologic and Obstetric Investigation, 2014, 77(3): 194-200.

DOI：10.1159/000357489

• Asherman's syndrome
• Three-dimensional power Doppler angiography
• Open myomectomy

Aims: To present a study on severe Asherman's syndrome after open myomectomy and investigate the possible reasons for this outcome.
Methods: This study involves a rare case of a 38-year-old nulliparous woman who underwent a relatively minor and straightforward open myomectomy in a university hospital setting, during which the uterine cavity was not entered and there were no post-operative complications. Post-operatively the patient had oligomenorrhoea for over a year. The patient was investigated with three-dimensional power Doppler angiography of the uterus and underwent diagnostic/operative hysteroscopy. Main outcome measures were to sonographically assess the blood flow and vascularisation throughout the uterus and to hysteroscopically confirm diagnosis of Ashernnan's syndrome and treat the patient at the same time.
Results: Sonographically there was reduced perfusion in the outer part of the uterus and the scarred areas of the endometrium. Upon hysteroscopic confirmation of diagnosis, the division of adhe-sions led to a normal sized uterine cavity.
Conclusions: Among the predisposing and causal factors that have been implicated in post-operative adhesion formation, endometrial trauma, infection and tissue hypoxia are considered the most important. This case supports a role for tissue hypoxia in the development of Asherman's syndrome after open myomectomy.

• 出版日期2014