Presentation
Pelvic pain with secondary amenorrhea following uterine curettage 1 year prior.
Patient Data
The MRI sequences demonstrate:
a focal defect at the fundus of the uterus, extending along the thickness of the uterine wall up to the endometrial cavity, filled with mesenteric fat in keeping with uterine perforation
a thin band of low T2 crossing the uterine cavity, extending from the fundal defect up to the isthmus in keeping with Asherman syndrome (or synechiae)
a right ovarian unilocular cyst (35 mm) with homogeneous fluid content
mild effusion in the Douglas pouch
The ultrasound images demonstrate the fundal wall defect as well as a hyperechoic band adhesion (fibrosis) across the uterine cavity, indistinct from the endometrium.
Case Discussion
Uterine perforation is considered a serious complication that can occur as a result of any type of intrauterine procedure or implantation (such as IUCD insertion, hysteroscopic surgery, uterine curettage, and manual vacuum aspiration).
Asherman syndrome, also known as uterine synechiae, is a condition characterized by the formation of intrauterine adhesions secondary to trauma to the basal layer of the endometrium ( previous pregnancy, dilation and curettage, surgery, or infection such as TB endometritis) with subsequent scarring with risk of infertility.
Unable to process the form. Check for errors and try again.