Laparoscopic Management of Accessory Cavitated Uterine Mass: A Report of Two Cases and Review of Literature

Background: Accessory cavitated uterine mass (ACUM) is a rare congenital anomaly of Mullerian ducts that presents with severe dysmenorrhea in young women. It responds poorly to medication and requires surgical management for resolution of symptoms. Case: We report the cases of two young women who presented with medically refractory dysmenorrhea. They were initially diagnosed with subserosal fibroid and rudimentary uterine horn, respectively. After failure of all forms of medical treatment for dysmenorrhea, they underwent laparoscopy. Intraoperatively, we diagnosed them with ACUMs, and successfully performed complete laparoscopic excision and repair. Results: Histopathological evaluation in both cases confirmed the presence of endometrial glands and stroma in surrounding hyperplastic myometrium. Both of the patients experienced immediate and complete relief from dysmenorrhea postoperatively. Conclusions: Dysmenorrhea is a significant cause of loss of productivity and reduced quality of life in women. The usual algorithm of management in young women involves a variety of medical regimens, reserving surgery for only for severe unrelenting cases. Accessory cavitating uterine mass is a congenital anomaly that may present at any age, may be misdiagnosed, and is unresponsive to medical therapy. It requires a high degree of suspicion, proper evaluation with preoperative imaging, and first line surgical management for prompt relief.