Abstract:

We report a case of a 50-year-old female patient with adenomyosis complicated by an intramural uterine abscess and pyosalpinx. The patient was admitted due to abdominal pain and fever. Laboratory examinations indicated severe infection (leukocyte count: 47.05×10⁹/L) and imaging revealed significant uterine enlargement. Following initial empirical antibiotic therapy (imipenem/cilastatin sodium), infectious parameters partially decreased. However, the abdominal pain intensified and ascites developed, raising suspicion of abscess rupture. Emergency exploratory laparotomy with total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic adhesiolysis and enterolysis was performed. Intraoperative findings included purulent exudate in the pelvic cavity. Postoperative dissection of the uterine specimen confirmed multiple abscess cavities within the myometrium. Histopathological diagnosis was consistent with adenomyoma with superimposed infection and abscess formation. Postoperatively, based on etiological results, targeted antibiotic therapy and supportive care were continued, leading to successful infection control. This case highlights that adenomyosis may serve as a nidus for pelvic infection dissemination and the formation of deep intramural abscesses. For such complicated infections, if clinical condition deteriorates or abscess rupture is suspected despite potent antibiotic therapy, surgical intervention to control the source of infection is critical for successful management.

Key words: Adenomyosis, Abscess, Pyometra, Pelvic inflammatory disease, Therapy