Acute Abdominal Pain as a Result of a Ruptured Hematosalpinx: A Rare Complication of an Unusual Müllerian Anomaly

Abstract

Case Report

A 15-year-old virgin Caucasian female presented to the emergency room with a 40-hour history of acute left lower quadrant abdominal pain and nausea. Evaluation suggested a left pelvic kidney with obstructed ureter being the etiology. Her pain continued to escalate so further workup with laparoscopy was performed. This demonstrated a left pelvic sidewall hemi uterus with ruptured hematosalpinx. This is an unusual clinical presentation of a müllerian anomaly not previously documented.

Discussion

The differential diagnosis of acute unilateral abdominal pain in adolescent females should include müllerian anomalies. The incidence of this diagnosis is low but the evaluation and treatment can be performed in an expeditious manner if the diagnosis is considered. The laparoscopic excision of a unilateral noncommunicating uterine horn is a valid and recommended treatment approach of this rare malformation.

Introduction

Acute abdominal pain in an adolescent female is an unusual presentation in a patient with a congenital müllerian tract anomaly. More commonly this presents as chronic pelvic pain, dysmenorrhea or dyspareunia.¹ Therefore a müllerian anomaly is rarely considered in the differential as a cause of an acute abdomen. The low incidence of müllerian anomalies of 0.1–3.2% further obscures the initial differential diagnosis and appropriate management of this condition.² In this case report we present an unusual müllerian anomaly, a non-communicating pelvic sidewall hemi uterus, which presented with acute abdominal pain as the result of a ruptured hematosalpinx.

We believe the information provided in our report will be helpful to other physicians in the evaluation and treatment of unusual congenital müllerian anomalies in adolescence.