Alkhateeb Harith M, Yaseen Enas M
College of Medicine, Tikrit University, Iraq.
Int J Surg Case Rep. 2015;10:45-8. doi: 10.1016/j.ijscr.2015.03.023. Epub 2015 Mar 13.
A uterine malformation is a type of female genital malformation resulting from abnormal development of the Mullerian duct(s) during embryogenesis. The type and degree of uterine malformation depends on the level at which the fusion process of the two Mullerian ducts stops; thus, there is a wide variety of malformations. A newly described deformity called accessory cavitated uterine mass (ACUM) has been increasingly reported.
We report this deformity (in a 20-year-old married woman) which appears to be an additional incompletely developed, cavitated and presumably non-communicating uterus in addition to a normally shaped and developed uterus. The former uterus became impregnated with twins that died in a missed abortion at 13 weeks of gestation. Before discovering the presence of the deformity, three attempts were made to evacuate the dead fetuses by cervical dilatation and curettage of the normal empty uterus. These attempts resulted in perforation of its fundus, a laparotomy was performed to repair the uterus. During the laparotomy, the pregnant accessory uterus was discovered and was excised with the dead twins.
The lack of good medical history was a cause of the mismanagement of this patient. Most probably, the origin of ACUM is a growth from the right Mullerian duct. The ovum has entered the ACUM through the rudimentary tube and has been fertilized by a sperm travelled either through the normal vaginal and uterine cavities or through the lymphatics.
(1) A detailed case history is important. (2) An ACUM can be impregnated.
子宫畸形是一种女性生殖器官畸形，由胚胎发育过程中苗勒管异常发育所致。子宫畸形的类型和程度取决于两条苗勒管融合过程停止的水平；因此，畸形种类繁多。一种新描述的畸形，称为副腔化子宫肿块（ACUM），报告日益增多。
我们报告了这例畸形（发生在一名20岁已婚女性），除了正常形态和发育的子宫外，似乎还有一个额外的发育不完全、有腔且可能不连通的子宫。前一个子宫怀有双胞胎，在妊娠13周时稽留流产。在发现畸形存在之前，曾三次尝试通过扩张宫颈和刮除正常空子宫来清除死胎。这些尝试导致子宫底穿孔，遂行剖腹手术修复子宫。剖腹手术期间，发现了妊娠的副子宫，并与死胎一起切除。
缺乏完整的病史是该患者治疗不当的原因。ACUM最可能起源于右侧苗勒管。卵子通过残端管道进入ACUM，并被通过正常阴道和子宫腔或淋巴管游动的精子受精。
（1）详细的病史很重要。（2）ACUM可以受孕。
