Hysterectomy for Bulky Adenomyosis: What Surgeons Look For and Why It Matters
In this narrated case, Dr. Karli Provost Goldstein explains how a bulky adenomyotic uterus can place significant pressure on the lower pelvis, sacrum, and lower back, often described as feeling like “carrying a bowling ball.”
During this procedure, Dr. Goldstein highlights the importance of a full abdominal and pelvic evaluation, checking the bowels, appendix, and upper abdomen to ensure no hidden endometriosis remains at the time of hysterectomy.
Even when endometriosis is mild or peritoneal, adenomyosis can be dense and diffuse, invading the uterine wall and creating extreme bulk and pain. This patient, who was postmenopausal, underwent removal of both ovaries and fallopian tubes, with each step carefully staged for precision and visualization.
Because adenomyotic tissue can distort anatomy, surgical technique and structural reconstruction, including multi-layer closure of the vaginal cuff, are key to long-term pelvic stability and recovery.
