Diagnosis and laparoscopic excision of accessory cavitated u
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An accessory cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with normal endometrial lining lies within a normally functioning uterus. It is common among young and nulliparous women presenting with severe dysmenorrhea and infertility.
Presentation of the Cases

Here presented two cases of ACUM. The first case was a 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with non-communicating rudimentary horn .

The second case was a 36-year-old woman who presented with primary infertility and dysmenorrhea. Gynecological examination and ultrasound scanning were done for both patients. Subsequently, laparoscopic excision of the ACUM was performed on both patients. Histopathological examination confirmed the diagnosis.

Postoperatively, both patients did well, with no further dysmenorrhea. The second patient conceived spontaneously at the first attempt and at the time of writing was 33 weeks pregnant without any maternal or fetal problems.

In summary, the diagnosis of ACUM is often confused with non-communicating rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids. It is important to understand and distinguish ACUM. A thorough history, detailed gynecological examination and correct radiological modalities are critical to a proper diagnosis so that the correct surgery can be performed, especially when fertility is desired.

Learning points:

Accessory cavitated uterine mass is rare congenital Mullerian anomaly.

It happens among young, nulliparous women presenting with dysmenorrhea and infertility.

It is a diagnostic challenge and often confused with other differential diagnosis.

A thorough history, detailed and proper examination and imaging are mandatory.

Laparoscopic excision is crucial to relieve symptoms and improve reproduction.

Source: https://www.sciencedirect.com/science/article/pii/S2214911220300175