Müllerian Duct Research Articles

Role of Imaging in Rare Obstructive Reproductive Tract Anomalies: an Enigma—a Case Report

Mullerian duct anomalies (MDAs) result from abnormalities occurring during the embryologic development of mullerian ducts. Among the various mullerian abnormalities, obstructive reproductive tract anomalies (ORTA) form an interesting and difficult group to diagnose. This case series emphasize the role of imaging, specifically magnetic resonance imaging (MRI) in evaluating such cases before surgery. The clinical presentation of ORTA is in two ways, either with primary amenorrhea and pain or with menstrual periods and progressive dysmenorrhea. In ORTA, it is important to identify the site of obstruction, as surgical management depends upon the site of obstruction. Hence, the role of imaging is important in such cases. When suspecting MDAs especially ORTA, an initial screening ultrasound should be followed by MRI because of its multiplanar capability, excellent soft tissue characterization, and absence of ionizing radiation. All MRI examinations in our study were performed using 3 T MRI system using a phased array body coil. Here we are reporting three rare cases of ORTA presented to our institute where MRI identified the exact site of obstruction before surgery, leading to better preoperative planning. Hence MRI should be mandatory part of workup of this group of patients.

Does Excision of Mullerian Structures Jeopardize Testicular Growth and Function in Persistent Mullerian Duct Syndrome (PMDS): a Single Center Experience

Persistent Mullerian duct syndrome (PMDS) is a rare form of Disorders of Sexual Development (DSD) characterized by persistence of mullerian structures in a phenotypically and genotypically normal male. The most frequent clinical presentation is that of unilateral or bilateral cryptorchidism. Contrasting opinions exist among clinicians regarding the most suitable surgical intervention in this condition and the potential of fertility later. This study revisits PMDS in terms of varied modes of presentation and the optimum surgical approach to such patients. It, thus, attempts to throw light on the pattern of testicular growth and function within a reasonable follow-up time post-removal of mullerian structures and orchidopexy. The study was conducted in a tertiary health care center in North India. It was a retrospective study carried out by retrieving details of ten patients who had undergone treatment over a span of 9 years (January 2010 to January 2019). The clinical features, family history, surgery undertaken, and follow-up are hereby highlighted along with review of literature. Cryptorchidism was the most common presentation. Orchidopexy with excision of mullerian structures could be done in all except one. Testicular position, volume and vascularity, penile growth, and erection were assessed during subsequent visits at 3, 6, 12, and 24 months. All testes were descended with preserved and normal vascularity. Volumes were in normal range and all experienced good erection. Inference regarding fertility was not possible until conclusion of the study due to ongoing follow-up. Cryptorchidism is the most common presenting feature of PMDS. Familial involvement should be kept in mind. Orchidopexy should be the target surgery. Mullerian structures should be removed ensuring testicular viability. This, when performed carefully, ensures normal testicular maturation. However, long follow-ups will be required for conclusive evidence on fertility.

Office Hysteroscopy Versus Three-Dimensional Ultrasound in Assessment of Uterine Cavity in Recurrent Pregnancy Loss

Background: Recurrent pregnancy loss [RPL] is one of the most frustrating and difficult areas in reproductive medicine. Aim of the work: This prospective study aims to evaluate the roles of ultrasound and hysteroscopy in recurrent pregnancy loss. Patients and Methods: A total of 100 patients who had a history of two or more RPL had been included. All patients had been subjected to complete history taking, thorough clinical and gynecological examination, three-dimensional [3D] ultrasound and hysteroscopy. Results: The mean age was 27.43 years. In addition, 45% of the included females had two previous RPL while 55% of them had three or more RPL. Hysteroscopy revealed normal findings in 80 cases [80%], endometrial polyp in 7%, submucous myoma in 3%, uterine septum in 6%, and uterine synechiae in 4%. On the other side, three-dimensional ultrasound [3D US], normal findings had been detected in 83 cases [83%], endometrial polyp in 6%, submucous myoma in 3%, uterine septum in 5%, bicornuate uterus in 1%, and uterine synechiae in 2%. There was a statistically significant correlation between the two techniques in detection of the uterine findings in cases of RPL [p =0.001]. Conclusion: Three-dimensional ultrasonography is the best tool for diagnosis of different types of Mullerian duct anomalies whereas hysteroscopy is better in diagnosis of intracavitary lesions.

Seminoma in a Transverse Testicular Ectopia: A Rare Case Report

Transverse testicular ectopia (TTE) is an extremely rare congenital anomaly of the testis, characterized by migration of one testis toward the contrary hemiscrotum. TTE is usually associated with other testicular abnormalities such as persistent Mullerian duct syndrome, hypospadias, true hermaphroditism, and scrotal anomalies. Testicular sonography is the main initial diagnostic modality, followed by magnetic resonance imaging of the scrotum. These imaging modalities are important for determination of TTE and characterization of the testicular lesions. This case report provides the high-resolution ultrasonography, Doppler ultrasonography, magnetic resonance imaging, and diffusion-weighted imaging findings of a young man with seminoma in the transverse testicular ectopia. In addition, data on tumor stiffness, obtained with point shear-wave sonoelastography, are presented.

PERANAN MRI ABDOMEN PADA KASUS HERLYN WERNER WUNDERLICH

Background: Herlyn-Werner-Wunderlich syndrome (HWW) is a very rare genetic syndrome, a combination of anomalies between the mullerian and mesonephric ducts characterized by uterine didelphys, hemivaginal obstruction, and ipsilateral renal agenesis, also known as Obstructed Hemivaginal syndrome and Ipsilateral Renal Anomaly (OHVIRA). Magnetic Resonance Imaging (MRI) is an effective diagnostic support tool for finding out anatomical abdominal abnormalities with the right choice of protocol sequences to obtain optimal MRI images.
 Method: This study used a qualitative descriptive approach by presenting a case of a 20 year old female patient who had complaints of lower abdominal pain, no previous medical history and irregular menstruation. MRI Abdomen without contrast was performed using an MRI 1.5 Tesla signa explorer GE Healthcare at EMC Tangerang Hospital. Using the Coronal T2 SSFSE sequence, T1 fat sat LAVA, Axial T2 SSFSE, T1 fat sat LAVA breath hold method and Coronal 3D IFIR (MRA renal without contrast). Specifically for the pelvic area with the Axial T2 Propeller, Coronal T2 fat sat, and Sagittal T2 sequences.
 Result: In the Axial T2 propeller sequence, pelvic area retrieval revealed two separate uterine corpuses (uterus didelphys) accompanied by a heterogeneous oval lesion most likely originating from the left side of the vagina (hemivagina). Whereas in the Coronal T2 sequence the whole abdomen was taken and confirmed by the Coronal 3D IFIR, the right kidney was anatomically visible while the left kidney was not visible (agenesis).
 Conclusion: Abdominal MRI is a very accurate diagnostic tool to perform Herlyn-Werner-Wunderlich (HWW) syndrome without contrast agent with SSFSE T2 sequences, T2 propeller and 3D IFIR which have an important role in visualizing the quality of MRI images.

Colonic Epithelium Type Lining of Prostatic Utricle Cyst—A Rare Entity

Serendipitous detection of midline prostatic cysts is on the rise with the advancement in imaging facilities. They may arise from the Prostatic utricle (PUC), Mullerian ducts remnants, seminal vesicles or prostatic duct. PUC may present as a perineal swelling or with lower abdominal pain and pressure symptoms in case of intrapelvic location. An 18-year gentleman presented with chronic lower abdominal pain and dysuria. An evaluation revealed a midline prostatic cyst communication with the urethra via the PUC opening.

Double uterus with single cervix.

Mullerian duct anomalies are congenital defects of female genital system that arise from abnormal embryological development of the mullerian ducts. A didelphys uterus, also known as double uterus is one of the least common amongst mullein duct anomalies. This report discuss a case of 25 years old girl, married since 6 years with one missed miscarriage 4 years back. Her complains were severe dysmenorrhea and dyspareunia. Ultrasound scans showed double uterus with left ovarian endometriosis cyst. On laparotomy there was right sided communicating rudimentary uterus with small fallopian tube and normal ovary attached to it. Another enlarged non communicating uterine horn was present at right side, with dilated tube and cystic ovary attached to it. Resection of noncommunicating uterine horn with salpingoopherectomy was done.

SUN-074 Loss-Of-Function Mutations in GATA4 in Patients with 46,XY Disorders of Sex Development Without Cardiac Defects

Background: Disorders of sex development (DSD) encompass a wide range of conditions associated with numerous causative genes. In about 50-60% of 46,XY DSD individuals, the underlying molecular cause remains uncertain. GATA4 haploinsufficiency has been described in patients with congenital heart defects (CHD), while only a few studies reported mutations related to 46,XY DSD phenotype. This study investigated clinical phenotypes and molecular characteristics of two 46,XY DSD patients with GATA4 mutations. Methods: Mutation analysis was performed in patients with 46,XY DSD by whole exome sequencing (WES) using Illumina NextSeq platform. Clinical and endocrine characteristics were reviewed retrospectively. GATA4 variants identified by WES were verified by Sanger sequencing. Functional activity of GATA4 variants was tested by luciferase reporter assay on the SRY and AMH promoter using two different cell systems including HEK293 and NCI-H295R. Results: Subject 1 presented with micropenis and hypospadias at the age of 5 months. Karyotype was 46,XY. Mullerian duct remnants were not found in pelvic ultrasound. The patient underwent urethroplasty at the age of 10 months and was reared as a male. Subject 2 with complete female external genitalia was referred to our hospital because of 46,XY karyotype on G-scanning. The patient underwent laparoscopic orchiectomy at the age of 1.8 years and was assigned as a female. Both patients were responsive to hCG stimulation tests and did not have CHD. Subject 1 harbored a novel heterozygous variant of c.643A>G (p.R215G)] in GATA4, whereas a previously reported variant of c.1220C>A (p.P407Q) was identified in Subject 2. In vitro luciferase reporter assays using SRY and AMH promoter revealed decreased transcriptional activity of both p.P407Q and p.R215G. Conclusions: This study expanded phenotypic spectrum of mutations in GATA4 in patients with 46,XY DSD without CHD. GATA4 mutations in patients with 46,XY DSD may not be associated with CHD. Possible explanations for phenotypical variability comprise incomplete penetrance, variable expressivity, and oligogenic mechanisms.

Laparoscopic Management of Persistent Müllerian Duct Syndrome

Persistent Mullerian duct syndrome (PMDS) is characterized by persistence of Mullerian derivatives in a phenotypically and genotypically normal male. These patients have 46 XY karyotype with normal male external genitalia, virilization, and internal Mullerian duct structures. Typically, these patients have unilateral or bilateral undescended testes, bilateral fallopian tubes, a uterus, and an upper vagina draining into a prostatic utricle, as reported by Diamond and Uy (n.d.). We report a case of PMDS in a 25-year-old male, which present with primary infertility with bilateral cryptorchidism.

A young girl with right ovarian torsion and left ovarian ectopy

BackgroundMayer-Rokitansky-Küster-Hauser (MRKHS) syndrome refers to congenital hypoplasia/aplasia of the uterus, the cervix and the upper 2/3 of the vagina, in females with normal ovaries and fallopian tubes, secondary sexual characteristics and 46 XX karyotype. This condition originates from abnormal development of Müller’s paramesonephric ducts in the early stages of embryonic development. Kidney agenesis or malformations are the most commonly associated with unilateral kidney agenesis. Ovaries may be ectopic in 16–19% of MRKHS patients. Primary amenorrhoea, due to the absence of the uterus, is the most common presentation. Female karyotype confirmation is mandatory to differentiate it from complete androgen insensitivity syndrome and 17-alpha-hydroxylase deficiency. The management of MRKHS is multidisciplinary in order to encompass psychological, medical and surgical issues.Case presentationA four-year-old girl, presented to the emergency department complaining of left groin swelling noted 2 days earlier. The patient had recently been evaluated for an episode of acute abdominal pain and vomiting, with a final diagnosis of right ovarian torsion. At that time, the ultrasound imaging was not able to identify the left kidney, the left ovary and uterus. Surgical abdominal exploration confirmed the right ovarian torsion and was not able to identify the left kidney and the left ovary. Only a remnant of the uterus was present. Therefore, the right ovary was removed, and a diagnosis of MRKHS was made. Ultrasound imaging showed a left inguinal hernia. The hernial sac consisted of a solid oval vascularized formation suggestive of an annexe. The patient underwent a surgical procedure to correct the left inguinal hernia. In the operating setting, the presence of a vascularized, ectopic ovary carrying the tuba inside the hernial sac was observed.ConclusionsIn front of a patient with ovarian torsion and anatomical features suggestive of MRKHS, both the ovaries should always be searched for, with a high suspicion threshold for extrapelvic ovary. Identifying the ectopic ovary, in this case, helped to preserve patient fertility, avoiding a possible torsion.

A Rare Case of Persistent Mullerian Duct Syndrome and Review of Literature

Introduction: Persistent Mullerian duct syndrome (PMDS) is a scarce type of male pseudohermaphroditism due to anti-Mullerian hormone dysfunction. So, Mullerian duct derivatives such as the uterus, cervix, fallopian tubes, and two-thirds of the vagina are seen in a normal phenotypic and genotypic male. Considering and assessing the clinical manifestations, associated diseases, histopathology, and imaging findings can be clues in the management of such cases. Case Presentation: Here, we describe a case of PMDS with left inguinal hernia and bilateral cryptorchidism and discuss the management and review of the literature. Also, the case has a history of brain mass with a pathologic diagnosis of ganglioneuroma. Is there a correlation between PMDS and extragenital neoplasm? it needs more investigation in the future. Conclusions: Bilateral cryptorchidism could provide us with a hint toward PMDS diagnosis. However, genetic counseling will be required, particularly in parental consanguinity.

Detection and Treatment of Persistent Mullerian Duct Syndrome With Transverse Testicular Ectopia

The coexistence of persistent Mullerian duct syndrome (PMDS) with transverse testicular ectopia (TTE) is extremely rare. Due to a lack of distinctive clinical features in the early stages, PMDS coexists with TTE is usuallydiagnosed when patients are examined for other diseases,including cryptorchidism and inguinal hernia. We present a case of a 51-year-old man who presented with a recurrent left indirect inguinal hernia for 2 years and right congenital cryptorchidism. The patient was diagnosed as PMDS with TTE by preoperative magnetic resonance imaging and underwent laparoscopic resection of the right transverse ectopic testis and Mullerian duct residues.

Role of three-dimensional transvaginal sonography compared with magnetic resonance imaging in diagnosis of Mullerian duct anomalies

BackgroundMullerian duct anomalies are a heterogenous group of congenital anomalies due to abnormalities during the ductal development, fusion, or alteration of septal resorption. These lead to the occurrence of different uterine anomalies. The present study aimed to assess the value of three-dimensional transvaginal sonography (3DTVS) in comparison with pelvic MRI to diagnose uterine anomalies. We prospectively evaluated 30 female patients, from January 2016 to May 2017. Their ages ranged from 18 to 40 years. Cases were referred from obstetrics and gynecology clinic with suspected uterine anomalies by 2DUS or with HSG done for infertility workup. 3DTVS and MRI examination were done for all patients.ResultsThe final diagnosis of patients by MRI according to The European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy consensus classification included 2/30 (6.7%) patients classified as class U0, 4/30 (13.3%) patients classified as class U1, 17/30 (56.7%) cases classified as class U2, 2/30 (6.7%) patients classified as class U3, 3/30 (10%) patients classified as class U4, and 2/30 (6.7%) patients were classified as class U5. There was a significant strong agreement between the diagnosis by 3D-transvaginal ultrasound and MRI (P < 0.01).Conclusion3DTVS proved to be highly accurate in the diagnosis of uterine anomalies and showed strong agreement with MRI, as both can provide valuable information about both the internal details and the external contour of the uterus.

Role of Ultrasound and Magnetic Resonance Imaging in Assessment of Müllerian Duct Anomalies

Abstract Background Müllerian duct anomalies (MDAs) occur as a result from abnormal development of the uterus, cervix, and upper vagina. Many classification systems are presented, aiming to provide a more suitable and accurate categorization of female genital anomalies. Ultrasonography (US), Magnetic Resonance Imaging (MRI), or a combination of both are considered the gold standard in evaluation of uterine anomalies. Aim of the Work The main purpose of the study is to determine the diagnostic role of MRI and US in assessment of Müllerian duct anomalies and its subtypes. Patients and Methods This prospective analytical study was conducted at 14 patients suspected to have MDAs at Al-Demerdash Hospital-Ain Shams University in the period from September 2017 to May 2018, Their ages ranged from 15-40 year-old. All cases underwent Pelvic U/S and MRI, findings were correlated with laparoscopy. Results In this study the Mullerian duct anomalies were categorized into four groups: (a) congenital absence of the Müllerian ducts, or the Mayer-Rokitansky-Kuster-Hauser syndrome (n = 8), (b) disorders of vertical fusion (n = 1),(c) disorders of lateral fusion (n = 3) and (d) MDAs mimics(n = 2).MRI allowed correct diagnosis of 14 uterine anomalies (accuracy 100%) whereas US was correct in 13 out of 14 cases (accuracy 92.8%). Conclusion Two dimensional ultrasound stands as the first imaging modality of choice. MRI remains the reference imaging modality in diagnosis of Mullerian anomalies and it is subtypes and should be preserved for doubtful or complex cases.

Neovagina creation using sigmoid colon in vaginal agenesis: a case report and review of literature

Mullerian duct anomalies are rare and can present with abnormalities in upper vagina, cervix, uterus, and fallopian tubes. The exact incidence of cervicovaginal agenesis is unknown and there are very few cases recorded in the literature. Authors report a 12-year-old girl referred from gynaecologist with chronic cyclical abdominal pain with underdeveloped, geniatilia and developed secondary sexual characters. Radiological investigations showed hypoplastic cervix with hematometra and left hemato salpinx. A definitive repair with creation of a neovagina using a sigmoid colon segment was performed in a single stage. Many techniques are described for reconstruction of cervicovaginal canal. Use of colon in creation of a neovagina is described by authors. Here we report a case of complete vaginal agenesis presenting with Hematometra-Hematosalpinx where a neovagina was created using a segment of sigmoid colon. Single staged surgery for neovagina creation using segment of sigmoid colon offers a promising and safe alternative for cervicovaginal agenesis.

Transverse Testicular Ectopia with Persistent Mullerian Duct Syndrome: Presentation and Management

Transverse Testicular Ectopia with Persistent Mullerian Duct Syndrome: Presentation and Management

Epidermoid Polycystic Ovaries and Uterine Hypoplasia in a Cow

Background: Ovarian cysts originate from mature follicles that do not ovulate within the predicted time according to the oestrous cycle. Dermoid cysts are structures lined by keratinized stratified squamous epithelium, without adjacent epidermal structures, filled by keratinic debris and amorphous proteinaceus material. They are small, located below the cortex, near the hilus. There is controversy regarding the teratogenicity of the dermoid cyst. Some authors use the nomenclature of benign cystic ovarian teratoma, others, reports that although the fibrous wall and histological features are similar to teratomas, it is not associated with this germ cell-derived neoplasia.Case: Ovaries and uterus were received from a female, adult bovine, Nelore, from a slaughterhouse. The left ovary measured 6.5x5.0x3.9 cm and weighed 80 g; the right ovary measured 5.7x3.7x3.0 cm and weighed 60 g. Grossly, the ovaries were similar, presenting floating consistency, multilobulated and pointed aspect, and at the cut surface, there was extravasation of mucopurulent content of whitish colour. Regarding to the uterus, macroscopically, the uterine horns were infantile and decrease in the diameter. Fragments of the tissues were collected and fixed in 10% buffered formalin for histopathological examination and the staining of the slides was done with hematoxylin and eosin. Microscopically, in the ovaries, it was observed rare vestigial elements of ovary identifying an atresic follicle. Polycystic formation with cysts exhibiting partial or total coating of a keratinized squamous epithelium was also observed. In the lumen abundant keratinous material was present. The uterine microscopy revealed compact endometrium with areas variably infiltrated by lymphocytes, plasmocytes and occasional neutrophils. Areas devoid of endometrial glands were observed, in addition to other areas with reduced quantity and size. Also, the myoepithelial layer was thin and enlargement of the endometrial vascular space was noted.Discussion: Only one study was found reporting three cases of unilateral dermoid cyst in bovine ovary, also from slaughterhouse. Dermoid cysts appear most often in Zebu cattle. Clinically, these cysts do not necessarily result in infertility and do not interfere in the ovarian functions, due to this, the ovaries are not referred for histopathology examination, which difficult its classification. However, in this study the histological examination showed the absence of follicular development, which characterizes infertility, including endocrine dysfunction. Macroscopically ovarian dermoid cysts are similar to abscesses. It has a viscous or milky content inside and, at the cut surface, usually the content project to the surface. Histologically, there are dilated cysts containing material in the lumen at various stages of keratinization conferring a lamellar aspect and a keratinized stratified squamous epithelium. In this study, we observed pseudostratified epithelial lining containing cilia in addition to lumen keratin content, without follicles or adnexal structures, corroborating the findings in the literature. Also, it was observed uterine hypoplasia, which occurs due to failure of the development of the paramesonephric ducts during embryonic development. Ovarian dermoid cysts associated with uterine hypoplasia are infrequent in animals and, clinically, may not present changes in fertility and ovarian function.

Uterus Didelphys dengan Agenesis Servik Bilateral

Background : The mullerian duct anomaly is a congenital abnormality of the female reproductive system caused by abnormal embryological development during pregnancy. If accompanied by cervical agenesis and infertility, intervention must be taken. Accurate diagnosis and proper treatment are very crucial to the future of reproduction and treatment of infertility in patients. Objective : Reporting the handling of cases of uterine didelphys accompanied by bilateral cervical agenesis. Method : Case report Case : Reported cases of women aged 34 years with primary amenorrhea and 9 years primary infertility, not typical cyclic pain, normal secondary sex development and from gynecological examination obtained cervical agenesis. Transvaginal ultrasound examination found a mass with the appearance of adenomyosis. Laparoscopic performed show 2 masses, 1 mass resembling adenomyosis with a size of 9x6x5cm located lateral to the left pelvis and another mass in the form of a hypoplastic uterus with a size of 2x2x1cm visible 2 tubes with 2 ovaries within normal limits. Uterine mass resembling adenomyosis with a location far from the vagina making it difficult to do anastomoses while other uterus hypoplasia and non-functional. Hysterectomies were performed on the mass of adenomyosis with the results of PA was adenomyosis. Conclusion : The uterus didelphys with bilateral cervical agenesis with 1 uterine adenomyosis and located in the pelvic lateral it was difficult to do uterovaginal anastomose so that hysterectomy was performed. Second uterine was hypoplasia and non-functional so that no action was taken. Need to think about "future fertility" in these patients and various options for having children. Keywords: Primary Amenorrhea, Uterine Didelphys, Cervical Agenesis, Adenomyosis

Uterus Didelphys dengan Agenesis Servik Bilateral

Background : The mullerian duct anomaly is a congenital abnormality of the female reproductive system caused by abnormal embryological development during pregnancy. If accompanied by cervical agenesis and infertility, intervention must be taken. Accurate diagnosis and proper treatment are very crucial to the future of reproduction and treatment of infertility in patients.Objective: Reporting the handling of cases of uterine didelphys accompanied by bilateral cervical agenesis.Method : Case reportCase: Reported cases of women aged 34 years with primary amenorrhea and 9 years primary infertility, not typical cyclic pain, normal secondary sex development and from gynecological examination obtained cervical agenesis. Transvaginal ultrasound examination found a mass with the appearance of adenomyosis. Laparoscopic performed show 2 masses, 1 mass resembling adenomyosis with a size of 9x6x5cm located lateral to the left pelvis and another mass in the form of a hypoplastic uterus with a size of 2x2x1cm visible 2 tubes with 2 ovaries within normal limits. Uterine mass resembling adenomyosis with a location far from the vagina making it difficult to do anastomoses while other uterus hypoplasia and non-functional. Hysterectomies were performed on the mass of adenomyosis with the results of PA was adenomyosis.Conclusion: The uterus didelphys with bilateral cervical agenesis with 1 uterine adenomyosis and located in the pelvic lateral it was difficult to do uterovaginal anastomose so that hysterectomy was performed. Second uterine was hypoplasia and non-functional so that no action was taken. Need to think about "future fertility" in these patients and various options for having children. Keywords: Primary Amenorrhea, Uterine Didelphys, Cervical Agenesis, Adenomyosis

A rare incidental case of an accessory fallopian tube

Developmental anomalies of the mullerian duct system represent one of the most fascinating disorders that obstetricians and gynecologists encounter as the mullerian ducts are the primordial anlage of the female reproductive tract. Accessory fallopian tube is one such rare anatomical mullerian duct error that has been occasionally reported in the literature. Due to the limited data available and lack of awareness about this entity, it is often overlooked. This report describes one such rare incidental case of an accessory fallopian tube in a 35-year-old female who was diagnosed with right ruptured tubal pregnancy. The patient was about six weeks pregnant and presented with a severe lower abdominal pain. Transvaginal sonography showed that the right fallopian tube contained a gestational sac with a yolk sac and her urine pregnancy test was positive, so a diagnosis of a right ruptured tubal pregnancy was made. Laparotomy and right salpingectomy were performed. Histopathological examination revealed right ruptured tubal pregnancy with a coexisting accessory fallopian tube. In conclusion, an early identification and prompt intervention are paramount for treating such an anomaly as it can have many gynecological detrimental implications.