Ala Uwais1, Kuan-Gen Huang2, Maria Crizelda Valino3, Luay Abu Atileh4. 1. Department of Obstetrics and Gynecology, Mutah University, Amman, Jordan. 2. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan. 3. Department of Obstetrics and Gynecology, De La Salle University Medical Center, Dasmarinas, Cavite City, Philippines. 4. Department of Obstetrics and Gynecology, Albasheer Hospital, Amman, Jordan.
A 56-year-old woman who previously had a total abdominal hysterectomy for myoma was admitted for the left lower quadrant pain with ultrasound and computed tomography scan findings of the left ovarian mass torsion, and subsequently, operative laparoscopy was done. Intraoperative findings showed dense pelvic adhesions with multiple endometriotic implants.The surgery started with extensive adhesiolysis, and on opening the retroperitoneum and dissection to identify the left ureter, it was noticed that there were two tubal structure alongside each other, and peristaltic movement was seen separately [Figure 1]. The operation then proceeded with left salpingo-oophorectomy.
Figure 1
Laparoscopic view of pelvis showing left side double ureter variant
Laparoscopic view of pelvis showing left side double ureter variantDue to suspicion of duplication in the left urinary collecting system, intravenous pyelogram was performed and confirmed a duplication variant of the left urinary collecting system [Figure 2].
Figure 2
Pyelogram showing duplication in the urinary collecting system
Pyelogram showing duplication in the urinary collecting systemDuplication in the urinary collecting is a relatively common condition with an estimated incidence of 0.8%–1.8%,[1] and this congenital anomaly is more common in female, and asymptomatic in most cases.[2]There are different variants of urinary collecting system duplication, which usually including the ureter.[3]Identification of the ureter and ureterolysis may need during pelvic surgery, such as deep infiltrating endometriosis. Thus, surgeons must keep in mind the possibility of ureter duplication variants when they notice two tubal structure, to avoid ureteric injury.
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Figure 1
Figure 2