Round Ligament Research Articles

TOPOGRAPHY FORMATION OF THE UMBILICAL VEIN IN PREFETUS

Venous blood fl ow in the liver is unique because it is provided by two embryonic and functionally diff erent systems: the umbilical and portal hepatic or yolk systems.The largest tributary vessel of the liver in pre-fetuses is the umbilical vein (UV), which passes through the gap of the round ligament of the liver and gives from 2 to 5 branches to the left side of the liver and the same number to the square. At the level of the left edge of the transverse sulcus, the UV is divided into three termin branches: the posterior branch to the left lobe, the venous (Arantian) duct, and the anastomotic branch, through which the UV connects to the portal hepatic vein (PHV).To study the patterns and identify the features of the intrahepatic topography of venous structures, in particular the umbilical vein in the prefetal period of human ontogenesis.For the study, 50 objects of pre-fetuses were used. To achieve this goal, a complex of morphological research methods was used, including the method of morphometry, the production and study of a series of histological sections, macro- and microscopy, conventional and fi ne preparation under the control of an MBS-10 microscope, injection of vessels with the following radiography.At the beginning of the prefetal period of development (VII week), the liver occupies the cranioventral and middle sections of the abdominal cavity. Its transverse dimension is 4.8 mm (pre-fetus 19.8 mm of parietalcoccygeal length (PCL)) and 5.1 mm (pre-fetus 20.0 mm PCL).UV of pre-fetuses of the 7th week of development (14.0-20.0 mm PCL) was studied on 16 series of histological sections. It enters the liver in the area of the anterior edge of the left sagittal groove and is covered from below by the liver tissue. Along the way, it gives off 2-3 left side branches with a diameter of 40-50 microns, branching in the left lobe of the organ, and 1-2 right ones, entering the square lobe. The UV enters the liver parenchyma in the area of the anterior edge of the left sagittal sulcus and passes in the anterior- posterior direction within its anterior part. From below, the vein is covered with liver tissue.The outer diameter of the UV at the edge of the liver is 370 μm (pre-fetus 30.0 mm PCL), its length reaches 940 μm.In the course of the UV, it gives off 2-3 left lateral branches with a diameter of 98-102 microns, branching in the left lobe of the liver, within the future II, III and partially I and IV segments, and 1-2 right ones, entering the square lobe, ending in the future IV segment.Consequently, at the end of the prefetal period of development, the intrahepatic topography of the aff erent venous vessels (umbilical and portal veins) and their branches of 1-2 orders acquires certain features of the defi nitive one.

A rare case of left Nuck’s canal cystic endometriosis: Computed Tomography findings

Introduction:Endometriosis is a common and chronic gynaecological condition but the implant in the canal of Nuck constitutes a very unusual state with an estimated prevalence of 0.3%–0.6% of all endometriosis cases. The canal of Nuck is an abnormal patent pouch of parietal peritoneum extending anteriorly from the round ligament of the uterus into the labia majora, thus represents a communication between the peritoneal cavity and the female inguinal canal. This condition may permit the seeding of endometriotic tissue in the inguinal soft tissues, becoming a possible cause of inguinal swelling or pain.Case description:A 43-years-old woman presented with painful swelling in her left groin. Ultrasound and a subsequent pelvic computed tomography showed a cystic lesion as for a Nuck’s canal encysted hydrocele. The patient underwent an anterior open surgery and the histologic examination revealed an endometrium-like tissue in the cystic wall.Conclusion:In women presenting with painful swelling of the groin, despite its rarity, endometriosis of the Nuck’s canal must be differentiated from other more common pathologies like hernias, varicoceles, neoplasms, and lymphadenopathies. Imaging can aid in differential diagnosis, but the final diagnosis is entrusted to histology, which enable to exclude an underlying malignancy.

Features of the postcovid period in women in labor

Clinical manifestations in the abdominal cavity of a woman in labor, discovered during an urgent cesarean section at 41 weeks of gestation 2 months after an acute form of COVID-19, are described. The materials of medical documentation were analyzed and the features of the course of pregnancy by trimester, urgent cesarean section, postoperative period, laboratory parameters, ultrasound data, cardiotocography, fetal condition at birth and three days later were determined.Presentation of case. 33-year-old pregnant woman (pregnant for the first time) had COVID-19 at 26 weeks of gestation. At a cesarean section for urgent indications at 41 weeks of gestation during the revision of the abdominal cavity was found that the visceral peritoneum of the uterus along the anterior and posterior surfaces, fallopian tubes, wide and round uterus ligaments, ovaries and parietal peritoneum of the pelvis, areas of the serous intestinal layer were with expressive signs of edema covered with vesicular rash, in places in the conglomerate, which were bleeding. There was no abdominal effusion.The child was born with 7–8 points Apgar score and had a negative PCR result for COVID-19. Placenta measuring 25 x 21 x 5.0 x 0.5 cm with multiple petrification, single red heart attacks. The shells are distinctly yellow-gray-green in color. The umbilical cord is 70 cm long and usual color. Amniotic fluid is clear. The early and late postoperative periods and the postpartum period proceeded without complications. At once the disorders in the blood coagulation system, immune system, positive COVID-19 IgG and IgM were identified in mother. Videin, Magniсum-antistress, preparations of acetylsalicylic acid and for the comprehensive support of the physiological state of the intestine were used in the complex treatment of the postpartum period.Conclusion. COVID-19 disease is pathology with many unknowns. Therefore, each clinical observation is important for studying of its course. Post-COVID syndrome and long-COVID syndrome have individual characteristics. Collective experience will contribute to the definition of an algorithm for the therapy of patients and personalized dispensary observation after an acute period.

Modified vaginal hysterectomy for chronic non-puerperal complete uterine inversion: video presentation.

Chronic non-puerperal complete uterine inversion is a relatively rare condition. Abdominal Haultain's operation is the usual management. We present such a case with fundal fibroids managed by modified vaginal hysterectomy. Preoperative computerized tomography enhanced intravenous urogram depicted normal ureters and bladder. Diluted vasopressin (10 U in 100 ml normal saline) was infiltrated at the base of the myoma and a myomectomy was performed. The fundal raw area was pierced to reach the formed space between the anterior and posterior uterine serosa. The bilateral round ligaments were clamped, cut, and ligated. Diluted vasopressin was injected into the fundal anterior uterine wall and about 1 cm was excised. Then, the bilateral utero-ovarian ligaments were clamped, cut, and ligated. In the same way another 1 cm of anterior uterine wall was excised and the bilateral uterine vessels were clamped, cut, and ligated. The rest of the uterine wall area was infiltrated with diluted vasopressin circumferentially. An incision at the vesico-cervical junction was made and the bladder pushed up. The posterior fornix area was incised and the Pouch of Douglas (POD) opened. Vesico-uterine pouch opened under finger guidance placed through POD. The rest of the anterior uterine wall was excised. Exposed bilateral cardinal-uterosacral ligament complexes (CULCs) were clamped, cut, and ligated. The remaining vaginal attachments ligated hemostatically and the vault was closed. For vault prolapse prevention, vault closure suture ends were tied with ipsilateral CULC suture end, brought outside the vagina at vault angle. A follow-up visit up to 1 year found no complications. This novel reverse vaginal hysterectomy combining the principles of both abdominal and vaginal hysterectomy can successfully manage chronic non-puerperal complete uterine inversion.

Round Ligament Varicocele Masquerading as an Inguinal Hernia During Pregnancy.

Hernia is an exceedingly common pathology, to which inguinal hernias are frequently diagnosed. Though this entity is regularly seen, in pregnancy a different diagnosis must be excluded: round ligament varicocele (RLV). Round ligament varicocele has a similar presentation to inguinal hernia, and therefore is often misdiagnosed. Though misdiagnosis potentially occurs from a lack of knowledge of the disease, RLV has shown that it's at least as common as inguinal hernia in pregnancy. The issue with misdiagnosis occurs as there is significant difference in management; hernia may require operative intervention, while RLV follows a conservative course. Therefore, an accurate diagnosis is essential, and an incorrect diagnosis can be associated with an unnecessary operation and consequence. We present the case of a patient in her second trimester who was referred for surgery due to suspicion of an inguinal hernia, and review the literature for evaluation recommendations, appropriate diagnostic strategies, and management tactics for RLV.

Laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament without a uterine manipulator

ObjectiveTo demonstrate the experience of laparoscopic radical hysterectomy for cervical cancer without the use of a uterine manipulator and investigate the feasibility and treatment effectiveness of this surgical approach. Materials and methodsThe laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament without a uterine manipulator prevented the oppression of the uterine manipulator on the tumour. Vaginal ligation was performed below the lesion of cervical cancer, and the vagina was cut off below the ligation line. Consequently, the exposure of cancer tissues in the abdominal cavity was prevented, enabling a tumour-free operation. We reviewed the medical records of the 22 patients with stage IB1-IIA2 cervical squamous cell carcinoma who were treated at our hospital between May 2019 and February 2020. All the patients underwent the laparoscopic radical hysterectomy for cervical cancer by pulling the round ligament. All the patients were informed about the different therapeutic schemes and surgical approaches as well as their advantages and disadvantages. Information about operative time, intraoperative blood loss, hospitalisation duration, postoperative complications, postoperative adjuvant therapy, prognosis and other data were recorded. ResultsAll the surgical procedures were successfully completed without perioperative complications, such as vascular injury, pelvic injury and abdominal organ injury. The mean operative duration was 204 min, and the mean operative blood loss was 102 mL. The mean duration of postoperative hospital stay was 13 days. Nineteen patients received postoperative chemotherapy once before hospital discharge. Urinary retention was the major postoperative complication. All the patients were followed up for 14–23 months. The median follow-up time was 18 months. 21 of the 22 patients survived. No recurrence was detected in the patients during follow-up. One patient who had a pelvic lymph node metastasis but refused complete chemoradiotherapy died before the last follow-up. ConclusionsThis surgical approach appears to be safe and feasible for patients with cervical cancer. A larger sample size and longer follow-up period are required to confirm whether this surgical approach can actually and effectively improve the prognosis.

Leiomyoma originating from left round ligament presents as symptomatic inguinal hernia.

Leiomyomas may develop at extra‐uterine locations and pose diagnostic dile mmas. This is a case of a fibroma originating from the left round ligament presenting as a symptomatic inguinal hernia.

Symptomatic Round Ligament Leiomyoma in a Patient with Müllerian Agenesis

Symptomatic Round Ligament Leiomyoma in a Patient with Müllerian Agenesis

Evaluation of the distribution of mechanoreceptors in the hip joint with severe coxarthrosis in 9 patients: A histologic and stereological study

Due to its high mobility, hip joint plays a crucial role in executing many movements such as standing, sitting, running, crouching. The distribution of mechanoreceptors and neural elements in anatomical structures that provide stabilization of the hip joint is important in determining the optimal surgical incision site for the hip joint stabilizers in patients with coxarthrosis. Various studies have been conducted about the mechanoreceptors and distribution of neural elements in structures such as the transvers acetabular ligament, teres (round) ligament of femur, acetabular labrum and hip joint capsule with using various staining methods. To our knowledge, there is insufficient information about the mechanoreceptor distribution within the anatomic structures that participate in stabilization of the hip joint. This study is planned to examine the distribution of mechanoreceptors in the transverse acetabular ligament, teres ligament, acetabular labrum and joint capsule in samples obtained during the surgery who are operated for hip replacement surgery due to severe coxarthrosis. Each specimen was stained with silver impregnation technique and density of mechanoreceptors were estimated by stereological method. Teres ligament has the highest number of mechanoreceptors among all other specimens. Within the joint capsule, mechanoreceptors were most abundant at its antero-inferior part, whereas its anterior part contained the lowest number of mechanoreceptors. These results suggest that, as the anterior part of hip capsule bears the lowest number of mechanoreceptors, it might be safer for incision during total hip arthroplasty surgery.

Round ligament polypoid endometriosis presented with shoulder tip pain, a case report

Round ligament polypoid endometriosis presented with shoulder tip pain, a case report

A rare case of accessory liver lobe torsion in a pediatric patient who showed recurrent epigastralgia and who was treated by elective laparoscopic resection

BackgroundAccessory liver lobe (ALL) is a rare liver malformation. An ALL develops due to malformation of the endodermal caudal foregut and segmentation of the hepatic bud in the third week of gestation. Most ALLs are asymptomatic and are detected incidentally during abdominal surgery. The incidence of ALL is < 1% in patients who undergo abdominal surgery. However, some ALLs twist and cause acute abdomen. We experienced a pediatric case of ALL torsion in a patient who underwent elective laparoscopic surgery.Case presentationThe 5-year-old girl had a 3-month history of epigastralgia and vomiting, which occurred every 2 weeks. Abdominal ultrasonography with color Doppler imaging revealed an 11.8 × 13.6 mm nonvascular lesion with mixed echogenicity near the round ligament of the liver. Enhanced computed tomography confirmed a 14 × 16 × 20 mm low-attenuation mass surrounded by a hyperdense line and disproportionate fat stranding on the right side of the round ligament of the liver. There was no ascites or hemorrhage. These findings suggested an abscess of the round ligament of the liver. Her symptoms improved with the administration of oral antibiotics; thus, we planned to perform elective exploratory laparoscopy and subsequent resection. Two trocars (5 mm) were inserted through a multichannel port device at the umbilicus and one trocar (3 mm) was inserted at the right lateral abdomen. Upon observation of the abdominal cavity, the omentum was observed adhering to the round ligament of the liver. Macroscopic observation revealed no apparent mass lesions. We performed adhesiolysis of the omentum from the round ligament of the liver using a vessel sealing system. We performed resection at the site at which adhesion had formed between the round ligament of the liver with the surrounding tissue using a vessel sealing system and the resected specimen was extracted through the umbilical wound. The postoperative course was uneventful. A pathological examination revealed necrotic liver tissue. The resected tissue was founded to be an ALL with ischemic change.ConclusionsThe recurrent abdominal pain was induced by torsion of the ALL. Pediatric surgeons should consider ALL torsion as a differential diagnosis for epigastralgia of unknown etiology.

Excision of Deep Endometriosis Nodules of the Sciatic Nerve in 10 Steps

To present 10 standardized and reproducible surgical steps allowing for complete excision of deep endometriosis nodules involving the sciatic nerve. Surgical education video. The local institutional review board confirmed that the video met the ethical criteria required for publication. Patient consent was obtained. Tertiary referral center. The excision of deep endometriosis involving the sciatic nerve may be performed following 10 steps: (1) Longitudinal incision of the peritoneum covering the external iliac artery, from the hypogastric vessels to the round ligament and the identification of the genitofemoral nerve. (2) Dissection of the iliolumbar space identified laterally by the psoas muscle and medially by the external iliac artery and vein [1-5]. (3) Identification of the obturator nerve. The dissection is performed on contact with the psoas muscle; when the nerve is surrounded by the nodule, its releasing is progressively carried out. (4) Identification of the obturator vessels, which cross the obturator nerve beneath and follow a lateral direction. (5) Opening of the lumbosacral space, below the level of the obturator nerve, and the identification of the sciatic nerve, resulting from the confluence of L4 to S3 roots. During this step, the deep endometriosis nodule is identified on contact with the greater sciatic foramen. (6) Opening of the broad ligament, between the external iliac vessels and the umbilical artery, and identification of the obturator nerve, as it is usually performed in pelvic lymphadenectomy. The surgeon may either perform a separate incision of the posterior leaf of the broad ligament and medial to the infundibulo-pelvic ligament or prolong medially the incision made at step 1. (7) Identification of the sciatic nerve, which is seen below and medially from the obturator nerve and obturator vessels. During this step, the posterior limit of the nodule is identified. (8) Identification of sacral roots S1, S2, and S3 [6]. The pudendal nerve and the posterior femoral cutaneous nerve may be identified below the S3 and medially from the sciatic nerve and before their exit through the greater sciatic foramen. The posterior and medial limit of the nodule is progressively released [7]. (9) The dissection is continued laterally, on contact with the ischium, down to the ischial spine and the coccygeus muscle. The lateral limit of the nodule is identified and released. (10) The anterior limit of the nodule is identified and, when required, is separated from the bladder. The latter 3 steps are less standardized, and the surgeon may alternate lateral, medial, posterior, and anterior dissection of the nodule, depending on the intraoperative circumstances. In most cases, the nerves are compressed but not infiltrated inside the epineurium, and their complete releasing is followed by significant or complete relief of pain and motor problems [6]. When the nodule infiltrates the nerves inside the epineurium, the excision may be performed into the nerve. Laparoscopic excision of deep endometriosis nodules involving the sciatic nerve is a challenging procedure, requiring good anatomic knowledge, surgical skills, preliminary specific training, and multidisciplinary postoperative care. Teaching such a complex procedure is a mandatory but delicate task. By following 10 sequential steps, the surgeon may reduce the risk of hemorrhage originating from the external iliac, obturator, and pudendal vessels; preserve somatic nerves; and successfully excise deep endometriosis nodules. Although the 10 steps attempt to standardize the surgical approach in a challenging localization of deep endometriosis, they are not mandatory and should be adapted to the patient.

Novel Approach via the Round Ligament in Portal Vein Embolization.

The objective of this study was to describe the detailed technique and clinical outcomes of portal vein embolization via the round ligament (RL-PVE) prior to major hepatectomy. Between January 2010 and March 2020, a total of 50 portal vein embolization (PVE) procedures were performed in 50 patients. Of them, seven patients who underwent RL-PVE were enrolled in this study. Percutaneous transhepatic portal vein embolization (PTPE) was not indicated due to the following reasons: bile duct dilation (n = 4), difficulty in visualizing the portal vein on ultrasonography because of severe fatty liver (n = 1), large tumor size (n = 1), and combined surgery with staging laparoscopy (n = 1). The following were reasons for avoiding trans-ileocecal PVE: past laparotomy (n = 5), difficulty in accessing the portal vein due to a large tumor (n = 1), and purpose of preventing small intestinal adhesions before hepatopancreatoduodenectomy (n = 1). The percentage of functional hepatic remnant rates was calculated before and after RL-PVE. Technical success was achieved in all cases. Five patients underwent embolization of the right portal vein, while two underwent embolization of the left portal vein. The median operative time and blood loss during RL-PVE were 181min and 33g, respectively. Morbidity and mortality related to RL-PVE were not observed. The median functional hepatic remnant rate before and after PVE was 55.6% and 63.2%, respectively. Liver functions including Child-Pugh classification were equivalent before and after RL-PVE. The RL-PVE technique may be useful in elective cases for which it is difficult to safely perform PTPE or trans-ileocecal approaches.

A rare case report: left-sided gall bladder without situs inversus viscerum

Left-sided gall bladder without situs inversus viscerum is a rare clinical entity. A left-sided gall bladder is a rare congenital anomaly defined as a gall bladder attached to the lower surface of the left lateral segment of the liver, to the left of the inter-lobar fissure and round ligament. We reported our experience of one cases of left-sided gall bladder in a woman aged 45 years who underwent laparoscopic cholecystectomy for acute calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD) and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity. One previous case reported had shown cystic duct opened into the common hepatic duct on its right side in a patient with left sided gall bladder.

Laparoscopic Uterine Artery Occlusion Combined with Uterine-sparing Pelvic Plexus Block and Partial Adenomyomectomy for Adenomyosis: A Video Case Report

OBJECTIVE Adenomyosis usually causes dysmenorrhea and anemia. Clinically, it is difficult to be solved by medicine and traditional surgery, and hysterectomy is always performed for radical treatment. In this article, we introduce a new method which could control the dysmenorrhea and anemia through laparoscopic uterine artery occlusion (LUAO) combined with uterine-sparing pelvic plexus block, and partial adenomyomectomy for uterus perservation.

Cyst of canal of Nuck-a rare clinical entity: case series and review of literature

A small evagination of parietal peritoneum forms the canal of Nuck. By the first year of life this extension condenses into a fibrous cord. Cyst of canal of Nuck is a rare developmental anomaly. The inguinal canal is traversed by the spermatic cord in male and the round ligament of uterus in female. The processus vaginalis accompanies the round ligament through the inguinal canal through into the labium majus. This evagination of parietal peritoneum forms the canal of Nuck in the female. These cases are rarely seen in surgical practice. In this case series we described three clinical scenario of canal of Nuck and their management.

Feasibility of ovarian preservation as a stage in correcting the quality of life in young patients after gynecologic surgeries.

e17560 Background: The purpose of the study was to analyze the structure and activity of the blood flow in the preserved ovaries after gynecologic surgeries. Methods: We monitored 50 patients (mean age 35.8±0.5 years) using sonography after ovary-sparing hysterectomy for benign, precancerous and preinvasive malignant uterine diseases. For revascularization, the preserved ovaries were attached to the lateral wall of the small pelvis or to the base of round ligaments of the uterus. Results: Ovarian hypertrophy was recorded in 3 women during the first year of the follow-up; the ovaries returned to the initial size without correction by 24 months. By the third year of observation, 94% of women had normal gonadal sizes, and only 2 women had ovarian hypoplasia. During the entire observation period (3 years), in 91% of cases, we could visualize the regular maturation of follicles in the preserved ovaries, which indicated the preservation of ovulatory function. The use of Doppler techniques during 24 months of the follow-up demonstrated that the blood circulation in the attached ovaries after hysterectomy was decreased on the average by 20.3%, compared to the intact ovaries. Conclusions: After the critical period of hysterectomy, the blood flow in the ovaries in almost all patients remains sufficient during the first 2-3 years, stimulating the regular growth of follicles and maintaining the gonadal activity. The quality of life of the operated patients during the first three years of follow-up remains optimal without additional correction with hormone replacement therapy.

Role of 3D Coronal Ultrasound in Diagnosis of Accessory and Cavitated Uterine Mass: A rare Mullerian Anomaly

Accessory and cavitated uterine mass is rare developmental Mullerian anomaly.There is a non-communicating uterus-like mass that occurs contiguously along wall of uterus often underdiagnosed and needs expertise to identify. To raise awareness, provide information about this pathology and emphasize role of coronal 3D ultrasound in its diagnosis. A 28-year-old married female presented with dysmenorrhea and chronic pelvic pain. On ultrasound, a homogeneously isoechoic mass was noted in right lateral wall of uterus with central echogenicity. On 3D reconstruction, the main uterine cavity was normal and both cornu were visualized without any recognized Mullerian anomaly.No communication with the main endometrial cavity seen. On laparoscopy, mass was located under right round ligament insertion. Sectioning revealed chocolate colored fluid. ACUM is non-communicating uterus-like mass. It resembles uterus both macroscopically and microscopically. It represents a cavitated mass lined by endometrial glands and stroma surrounded by irregular smooth muscle cells. Criteriasfor diagnosing ACUM are (1) accessory cavitated mass located under round ligament; (2) normal uterus, fallopian tubes, and ovaries (3) surgical case with excised mass and pathological examination; (4) accessory cavity lined by endometrium with glands and stroma; (5) chocolate-brown fluid contents.On ultrasound, they appear solid isoechoic masses with central cystic areas separate from ovaries. 3D reconstruction can be used to rule out Mullerian anomaly. ACUM is a rare surgically treatable cause of dysmenorrhea, often underdiagnosed due to lack of knowledge about entity. 3D ultrasound can be highly accurate in making the diagnosis.

Anterograde intraoperative pancreatic stent placement and round ligament patch to prevent pancreatic fistula after distal pancreatectomy

Postoperative pancreatic fistula in distal pancreatectomy is one of the most important complications in this surgery and it is associated with high morbidity and mortality. Pancreatic fistula after distal pancreatectomy remains an unsolved problem and none preventive procedure has been shown effectively.We present a new technique that combine pancreatic stent placement with round ligament autologous patch over pancreatic edge.A guide is introduced through Wirsung duct prior to stent placement. After stent assessment, Wirsung duct is closed. Finally, falciform ligament autologous patch is placed over pancreatic edge. After 6–8 weeks, the stent is removed by oral endoscopy.This technique introduces a new issue on the pancreatic fistula prevention.

Imaging in gynecological disease (21): clinical and ultrasound characteristics of accessory cavitated uterine malformations.

To describe the clinical and ultrasound characteristics of accessory cavitated uterine malformations (ACUMs). This was a single-center observational study of consecutive patients diagnosed with an ACUM, who had undergone an ultrasound examination by an experienced ultrasound examiner between January 2013 and May 2019, identified retrospectively from medical records. ACUM was diagnosed when a cavitated lesion with a myometrial mantle and echogenic contents was seen within the anterolateral wall of the myometrium beneath the insertion of the round ligament. In all women, presenting symptoms and clinical history were recorded along with detailed descriptions of the lesions and any concomitant pelvic abnormalities. Twenty patients diagnosed with an ACUM were identified. Median age was 29.2 (interquartile range, 25.0-35.8) years. None of the women was premenarchal or postmenopausal. All of the women reported painful periods or pelvic pain and none of them reported subfertility. Twelve of the ACUMs were in the right anterolateral myometrium and eight were in the left anterolateral myometrium. Both a myometrial mantle and a fluid-filled cavity were considered to be defining features on ultrasound. The fluid contained within the cavity was either echogenic with a ground-glass appearance or hyperechoic. All of the lesions were spherical in shape. The Doppler flow seen in the outer rim was not markedly different from that of the surrounding myometrium, and the content of the cavity was avascular on Doppler examination. The mean outer cavity diameter of the ACUMs was 22.8 (95% CI, 20.9-24.8) mm and the mean internal cavity diameter was 14.1 (95% CI, 12.2-16.1) mm. Four women opted for transvaginal ultrasound-guided alcohol sclerotherapy. Surgical excision was carried out in eight cases, and the diagnosis was confirmed on histopathological examination in all of them. ACUMs are a uterine abnormality with a distinct ultrasound appearance, which are associated with dysmenorrhea and chronic pelvic pain. Knowledge of their typical appearance on ultrasound could facilitate early detection and treatment. There are several treatment options for ACUM, ranging from simple analgesia to complete excision. Further prospective and longitudinal studies are required to study the prevalence and natural history of this condition. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.