Design: Laparoscopic surgical excision of obstructed Müllerian remnant.

Setting: Pediatric tertiary care center

Patients or Participants: 13 year old girl with known renal anomaly who presented with severe refractory dysmenorrhea complicated by nausea and rectal pain.

Interventions: Due to patient's age, office examination was limited. Workup included pelvic transabdominal ultrasound and MRI as well as exam under anesthesia to assist in determining diagnosis prior to definitive surgery.

Measurements and Main Results: The patient was found to have an obstructed Müllerian remnant and a unicornuate uterus with solitary cervix contiguous with obstructed remnant. She was started on Norethindrone acetate for menstrual suppression. The patient underwent laparoscopic excision of the remnant with care to avoid injury to the remaining unicornuate uterus.

Conclusion: Patients with renal anomalies are at increased risk for Müllerian anomalies and should be evaluated at menarche for obstruction. The type of obstruction determines the appropriate surgical approach and menstrual suppression may be used to temporize patient discomfort. In this case, this 13-year-old patient with solitary kidney was found to have an obstructed Müllerian remnant which was excised laparoscopically.