P11.15: Diysmenorrhoea and endometriosis in a 14 year old girl—a rare report

This is a case report of a 14 years old girl, sent to the Gynecology appointment to evaluate for dysmenorrhoea. She had a previous diagnosis of right renal agenesis. The age of menarche was 11 years old, and the symptoms suggested primary dysmenorrhoea, more intense in the first day, and only partly relieved by ibuprofen. The symptoms had a slight improvement with the use of oral estroprogestatives. The physical examination revealed normal external genitalia, and the abdominal palpation was normal. A pelvic ultrasound revealed suggestive features of uterine duplication with two uterine structures converging towards the cervix. The development was slightly asymmetrical, larger on the right, where it showed intracavitary fluid, suggesting blind right hemiuterus. The pelvic CT confirmed the presence of didelphys uterus, with greater expression to the right body, suggestive of unicollis variant. The diagnostic laparoscopy showed didelphys uterus with blind right hemiuterus, endometriosis in the pouch of Douglas and in the bladder surface. Hydrotubation revealed flow of saline through the left fallopian tube. In the hysteroscopy, a single cervix and single uterine cavity with one tubal orifice were seen, corresponding to the left hemiuterus. After conversion to laparotomy, right hemi-hysterectomy was performed. Renal anomalies should raise the suspicion of genital malformations. The early diagnosis and treatment are important to avoid future complications such as endometriosis.