Minimally Invasive Management of a Mullerian Anomaly: A Clinical Decision-Making Tree

To describe the presentation and management of a symptomatic Müllerian duct abnormality in a teenager and propose an evidence based clinical decision-making tree on when to treat based on a thorough literature review.

A 17-year-old nulligravid woman presented with a 5-year history of menorrhagia, dysmenorrhea and pelvic pain with medical history significant for a congenitally absent left kidney and ureter. Pelvic ultrasound suggested a bicornuate uterus, but a pelvic MRI with/without contrast diagnosed her with a unicornuate uterus with a noncommunicating left rudimentary horn containing hematometra. The patient underwent surgical intervention with vaginoscopy, hysteroscopy, and eventually laparoscopic resection of left rudimentary horn, left salpinectomy, and an appendectomy which confirmed endometriosis. The patency of the right fallopian tube was confirmed with chromotubation and the patient's reproductive potential was maintained. Postoperatively, the patient was symptom free and started on hormonal suppression for endometriosis.

Based on this case and a thorough literature review we propose a clinical evidence based clinical decision-making tree on how to approach and treat mullerian abnormalities.

Müllerian duct anomalies require individualized management for symptom relief, prevention of complications, and preserving reproductive potential. Our clinical decision-making tree provides a guide for clinicians. Further research is needed to optimize long term outcomes of these rare conditions.