Pain Severity and Magnetic Resonance Imaging as Key Factors in the Management of Accessory Cavitated Uterine...

To describe surgical and non-surgical management strategies for accessory cavitated uterine malformation (ACUM), according to clinical symptoms and magnetic resonance imaging (MRI).

Retrospective multicenter observational cohort study including consecutive patients diagnosed with ACUM.

Three university-affiliated tertiary referral centers.

Thirty-two consecutive patients diagnosed with ACUM based on MRI criteria.

Patients meeting diagnostic criteria for ACUM were managed with surgery, sclerotherapy, or expectant observation after evaluation of lesion characteristics and symptom severity.

Evolution of pelvic symptoms according to management decision. Severe pelvic symptoms were reported in 79% of patients and 72% of lesions were predominantly extra-myometrial (FIGO type-6, 7, or 8) on MRI. Surgical management-predominantly minimally invasive excision of the accessory cavity with preservation of uterine integrity-was performed in 27 patients (84%). Among surgically treated patients, median visual analog scale (VAS) dysmenorrhea decreased from 8.5 (IQR 8-9) preoperatively to 1 (IQR 0-3) at follow-up, and median VAS chronic pelvic pain decreased from 8 (IQR 6-9) to 0 (IQR 0-3). No specific treatment was administered in 4 asymptomatic patients who remained symptom-free during follow-up. One patient underwent ethanol sclerotherapy with radiologic lesion regression and clinical symptom relief at follow-up MRI.

Although still underrecognized, ACUM typically presents with severe pelvic pain that can be effectively treated by minimally invasive excision while preserving uterine integrity. In selected cases, expectant management or sclerotherapy may also be appropriate alternatives.