Case of Unilateral Dysmen...

An 18-year-old female presented to the outpatient department on the sixth day of her menstrual cycle, reporting recurrent pain experienced throughout her menstrual periods over the past two years. The pain, primarily localized to the right lower quadrant, typically commenced preceding menstruation and peaked during its course. She reported intermittent use of analgesic medication to alleviate discomfort. Her vital signs were stable, with no systemic abnormalities. Past abdominal examination revealed tenderness at the right iliac fossa. USG was advised to exclude pelvic pathology, suggesting potential diagnoses of right-sided hematosalpinx, hematometra, and bicornuate uterus with a non-visualized right kidney. MRI confirmed a unicornuate uterus with a functioning rudimentary horn on the right, alongside right hematometra, hematosalpinx, right ovarian haemorrhagic cyst, and right renal agenesis. IV pyelography confirmed the latter. Cystoscopy showed non-visualization of the right ureteric orifice. Despite laparoscopy being preferred, laparotomy was chosen due to available facilities and expertise. During laparotomy, two uterine cornua were observed, with right-sided hematosalpinx and a haemorrhagic ovarian cyst. The right-sided, non-communicating rudimentary horn was incised, revealing a discharge resembling anchovy sauce. Excision of the right cornu and right ovariotomy were performed, preserving the left cornu and fallopian tube. Histopathological examination showed endometrial and myometrial tissue in the rudimentary horn, chronic salpingitis in the right tube, and a simple haemorrhagic follicular cyst in the ovary.