56. Rare Presentation of Müllerian Duct Anomaly

Abstract

<h3>Background</h3> Most congenital anomalies of the female reproductive system involve the uterus. Undescended fallopian tubes and ovaries are rare congenital defects and infrequently reported. Cases are usually discovered secondary to ectopic pregnancies or infertility. <h3>Case</h3> We present a 13-year-old postmenarcheal female who presented initially with left upper quadrant pain. Since preoperative imaging including an MRI of the abdomen was inconclusive, she underwent a diagnostic laparoscopy. Intraoperatively she was found to have a mass resembling a torsed accessory spleen adherent to an undescended fallopian tube as well as a small ovoid ectopic ovarian tissue. In the pelvis she was found to have a rudimentary left uterine horn which was associated with a truncated fallopian tube that appeared autoamputated; an enlarged left ovary with a simple ovarian cyst was noted as well. On the right side, a normal ovary, fallopian tube, and unicornuate uterus were noted. Pathology confirmed the mass was an infarcted accessory spleen associated with a portion of the fimbriated fallopian tube with a paratubal cyst, as well as ovarian tissue with a cystic follicle. Postoperatively she has done well with complete resolution of her pain. <h3>Comments</h3> Müllerian and splenic anomalies are rare, and co-presentation is rarer. Ultimately, clinical symptoms should guide surgical treatment and diagnosis of these rare anomalies.