Design: video footage of laparoscopic management of ACUM.

Setting: An accessory cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with normal endometrial lining lies within a normally functioning uterus. It is common among young and nulliparous women presenting with severe dysmenorrhea, infertility and recurrent pelvic pain despite taking analgesics or oral contraceptive pills 1,2. Diagnosis is a challenge, the typical MRI appearance is a large well-circumscribed round mass within the external myometrium, composed by an inner cystic hemorrhagic layer surrounded by a thick fibrous crown typically located just anterior to the uterine cornua and corresponding to the round ligament attachment 3,4. The uterine cavity has normal architecture, as well as the adnexa. The first line treatment is laparoscopic mass resection5.

Patients or Participants: A case of ACUM laparoscopic treatment in a 37 year old patient with chronic pelvic pain and severe dysmenorrhea is presented.

Interventions:

1-Bilateral retroperitoneal approach with bilateral dissection and preservation of ureters and hypogastric nerves.

2-Bilateral peritonectomy of posterior broad ligaments and retro cervix, excising endometrial foci and thickened uterosacral ligaments.

3- Approach of 2.5-cm myometrial mass located just anterior to the left uterine cornua and circumferential incision of the mass using monopolar diathermy.

4- Suture of the defect in 2 planes.

5-Chromopertubation confirming both fallopian tubes permeability.

Measurements and Main Results: ACUM laparoscopic treatment

Conclusion: ACUM is a diagnostic challenge and is often underdiagnosed. A thorough history, detailed gynecological examination and correct radiological modalities are critical so that the correct surgery can be performed in order to relieve the patient's distress. Its laparoscopic resection can be done safely and effectively. The challenge that the surgeon may encounter is to find the right surgical plane in order to achieve its complete resection.