Unusual presentation of a Gartner duct cyst in early pregnancy

Abstract

Introduction: Gartner ducts are vestigial remnants of the mesonephric ducts that regress after the eighth week of embryologic development. In the adult female, remnant Gartner ducts from the mesosalpinx to the cervix via the broad ligament and are typically located along the anterolateral vaginal wall. Cysts can arise when the ducts become obstructed and secretions from the remnant epithelium accumulate. Gartner duct cysts represent only about 11% of benign vaginal cysts. They often occur in pregnancy, but typically in the third trimester.Aim of Study: The purpose of this case report is to present a very unusual case of Gartner duct cyst that presented during the first trimester of pregnancy with our management strategy.Patients and Methods: After a 19-year-old primiparous patient presented with a painful midline vaginal mass in her first trimester, ultrasound and MRI were used to obtain the diagnosis of Gartner duct cyst. Bedside incision and drainage was performed to avoid general anesthesia for surgical excision.Results: The patient’s symptoms resolved after drainage, and she continued her pregnancy without complication. Complete healing of prior incision occurred with mild re-accumulation of glandular fluid. The patient had further symptoms.Conclusion: Gartner duct cyst should be on the differential diagnosis for a woman who has a midline vaginal cyst, even though they more typically occur more laterally. General anesthesia in the first trimester of pregnancy should be avoided. Therefore, we suggest bedside incision and drainage as an option for the management of symptomatic Gartner duct cysts in the patient who is not the ideal candidate for surgical excision