Laparoscopic excision of an accessory cavitated uterine malformation in an adolescent patient

Abstract

Objective: To demonstrate the laparoscopic, uterus-sparing excision of an accessory cavitated uterine malformation (ACUM) in an adolescent patient and to emphasize the importance of accurate preoperative imaging for intraoperative localization.

Setting: Tertiary referral center for minimally invasive gynecologic surgery.

Participants: An 18-year-old adolescent patient presenting with severe dysmenorrhea and chronic pelvic pain refractory to medical treatment.

Interventions: Laparoscopic excision of a noncommunicating accessory cavitated uterine lesion with preservation of the main uterine cavity.

Conclusion: Preoperative transabdominal ultrasonography and magnetic resonance imaging demonstrated a 35 × 43 mm cystic lesion located in the left anterior uterine wall, clearly separated from the endometrial cavity and consistent with ACUM. During laparoscopy, no obvious uterine bulging was observed, making intraoperative localization challenging. A targeted myometrial incision allowed identification and complete excision of the lesion, which contained chocolate-colored fluid and was lined with endometrium-like tissue. The main uterine cavity was preserved, and layered myometrial reconstruction was performed. Histopathological examination confirmed the diagnosis of ACUM. Laparoscopic uterus-sparing excision is a safe and effective treatment option for adolescent patients with ACUM when guided by accurate preoperative imaging.