Areiyu Zhang, MD, Faten F. Abdelhafez, MD, James Liu, MD, Mohamed A. Bedaiwy, MD, PhD
Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver, Canada (Drs. Zang, Bedaiwy). Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA (Drs. Abdelhafez, Bedaiwy, Liu).
Introduction: Müllerian anomalies can be challenging to diagnose. We describe a patient with uterus didelphys and cervical atresia who presented with a symptomatic pelvic mass that was incompletely diagnosed as an endometrioma. Consequently, it was inadequately treated at the time of laparotomy, necessitating a laparoscopic hemihysterectomy for definitive management.
Case Description: A 17-year-old nulligravida presented with abdominal pain and pelvic pressure. Computed tomographic imaging showed an 18-cm pelvic mass and left renal agenesis. The patient underwent an exploratory laparotomy with resection of a large endometrioma and left salpingo-oophorectomy. During the operation, an enlarged left uterine horn was observed and was kept intact. She made an uneventful recovery, but returned 6 months later with pelvic pain and pressure. Ultrasonography and hysterosalpingogram diagnosed uterus didelphys with left cervical atresia causing an obstructed hemiuterus. Laparoscopic hemihysterectomy with extensive adhesiolysis was performed, and the patient’s symptoms resolved.
Discussion: Endometrioma is rare in adolescents, and its presence should raise suspicion of a mu¨llerian anomaly. Laparoscopic management, while safe and feasible, is more challenging in the setting of dense adhesions from a prior laparotomy. Preoperative magnetic resonance imaging is recommended in adolescents who present with chronic pelvic pain and a symptomatic pelvic mass, to rule out a congenital anomaly and avoid a needless second surgery.
Key Words: Cervical atresia, Endometrioma, Hemihysterectomy, Müllerian anomaly, Uterus didelphys.