title: A rare case of Asherman's syndrome after open myomectomy: sonographic investigations and possible underlying mechanisms.
abstract: OBJECTIVE
  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 Asherman'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 adhesions 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.
authors.affiliation: Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London, UK.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papoutsis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgantzis
authors.forename: Maria Diletta
authors.initials: MD
authors.lastname: Daccò
authors.forename: Gabor
authors.initials: G
authors.lastname: Halmos
authors.forename: Mohsen
authors.initials: M
authors.lastname: Moustafa
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Mesquita Pinto
authors.forename: Adam
authors.initials: A
authors.lastname: Magos
mesh_terms: D000328:Adult; D005260:Female; D006175:Gynatresia / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D015907:Hysteroscopy; D009839:Oligomenorrhea / Q000209:etiology; D000267:Tissue Adhesions / Q000150:complications; D014463:Ultrasonography; D063186:Uterine Myomectomy / Q000009:adverse effects*; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging