Abstract: Introduction: A non-communicating, functioning endometrial cavity within the myometrium of an otherwise normal uterus is the hallmark of the uncommon Müllerian anomaly known as Accessory Cavitated Uterine Malformation (ACUM). It can be misdiagnosed for other gynecological disorders that frequently manifest as severe, refractory dysmenorrhea.
Case Report: A 16-year-old female presented with severe dysmenorrhea refractory to medical management since menarche, significantly impacting her daily activities. A year prior, an MRI done at a peripheral facility revealed endometriosis, bicornuate uterus, and polycystic ovarian syndrome (PCOS).
She was referred to a tertiary care center for further evaluation.
She was admitted with chronic discomfort that persisted even after taking medicine.
Accessory Cavitated Uterine Malformation (ACUM) was discovered in a subsequent MRI that was done after admission to the hospital. For final surgical care, a laparoscopy with the possibility of a laparotomy was scheduled due to her incapacitating symptoms and lack of response to medication.
Conclusion: This case highlights the diagnostic challenges in identifying ACUM, particularly in settings where radiological misinterpretation may occur. Awareness and early recognition are crucial to prevent misdiagnosis and prolonged morbidity in young patients with intractable dysmenorrhea.
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