Unilateral absence of the Fallopian tube and ovary with ipsilateral renal agenesis

Chisolum O Okafor; Charles I Okafor; Victor N Oguaka; Izuchukwu C Obionwu

doi:10.4103/1116-5898.127109

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CASE REPORT

Year : 2013 | Volume : 23 | Issue : 1 | Page : 21-23

Unilateral absence of the Fallopian tube and ovary with ipsilateral renal agenesis

Chisolum O Okafor, Charles I Okafor, Victor N Oguaka, Izuchukwu C Obionwu
Radiology and Gynaecology Unit, The Light Specialist Hospital and Maternity Umudim, Nnewi, Anambra State, Nigeria

Date of Acceptance	23-Sep-2013
Date of Web Publication	14-Feb-2014

Correspondence Address:
Chisolum O Okafor
Radiology Unit, The Light Specialist Hospital and Maternity Umudim, Nnewi, Anambra State
Nigeria

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1116-5898.127109

Abstract

A 36-year-old primiparous woman with one living child presented to our facility with 4 years history of secondary infertility and 20 weeks gestational age sized painful solid pelvic mass. Ultrasound scan, hysterosalpingography and intravenous urography revealed degenerated fibroids, bilateral tubal occlusion and single ectopic right pelvic kidney. Laparotomy revealed the absence of the left ovary and fallopian tube. This is a very rare finding. Whenever unilateral renal agenesis is found, the patient should be investigated for possible genital anomaly.

Keywords: Fallopian tube, hysterosalpingography, ovary, renal agenesis

How to cite this article:
Okafor CO, Okafor CI, Oguaka VN, Obionwu IC. Unilateral absence of the Fallopian tube and ovary with ipsilateral renal agenesis. Niger J Surg Sci 2013;23:21-3

How to cite this URL:
Okafor CO, Okafor CI, Oguaka VN, Obionwu IC. Unilateral absence of the Fallopian tube and ovary with ipsilateral renal agenesis. Niger J Surg Sci [serial online] 2013 [cited 2023 Apr 1];23:21-3. Available from: https://www.njssjournal.org/text.asp?2013/23/1/21/127109

Introduction

Unilateral absence of the fallopian tube and ovary is quite rare. The incidence reported in a large cohort of patients at laparoscopy and laparotomy (1968-1984) in Kuala Lumpur was 1 in 11, 241 females. ^[1] At autopsies, congenital unilateral renal agenesis was found in 0.93-1.8 of 1000 autopsies. ^[2],[3] Genital anomalies occur in 37-60% of females and 12% of males with congenital unilateral renal agenesis. ^[2],[3]

Unilateral renal agenesis is mostly found during incidental imaging examinations, ^[4] it can also be picked up during evaluations for early onset hypertension. Unilateral absence of the fallopian tube and ovary are most commonly diagnosed at laparoscopy or laparotomy for other indications. ^[5]

We report a case of unilateral absence of the ovary and fallopian tube co-existing with ipsilateral renal agenesis in a woman investigated for secondary infertility.

Case Report

Our patient was a 36-year-old primiparous woman with one living child, who presented with 4 years history of secondary infertility and painful abdominal mass. There was no menorrhagia and no history of previous surgeries. Patient had a normal delivery about 5 years; there was no history of pregnancy induced hypertension. She started desiring another pregnancy 4 years before presentation.

Examination revealed a young woman in no obvious distress, not pale with normal vital signs. A mildly tender, firm, irregular and mobile 20 weeks gestational age sized pelvic mass was found. Ultrasound scan revealed an enlarged uterus with multiple solid masses showing some degenerative changes. A single pelvic kidney was also found. Subsequent hysterosalpingography showed calcified uterine masses and bilateral tubal occlusion. Intravenous urogram [Figure 1] confirmed a single right pelvic kidney. The left kidney, pelvis and ureter were not visualized even in delayed film. Calcified pelvic masses (Leiomyomata) were also noted.

Figure 1: Intravenous urogram showing single right pelvic kidney and calcified fibroids

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Patient was counseled and prepared for laparotomy. At operation, an enlarged uterus with multiple fibroids, right fallopian tube and right ovary were found [Figure 2]. A total of eleven fibroid masses mostly subserous and intramural were removed. The largest measured 9 cm in the longest diameter is showing obvious evidence of calcification. The left wall of the uterus was blank, devoid of the fallopian tube, broad ligament and ovary [Figure 3]. Her post-operative recovery was uneventful.

Figure 2: Laparotomy showing the uterus with the right fallopian tube and ovary

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Figure 3: Laparotomy, showing left lateral uterine wall devoid of ovary and fallopian tube

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The couple is still hopeful of meeting their reproductive wish through in vitro fertilization.

Discussion

Failure of the ureteric bud to reach the metanephros results in renal agenesis. ^[6] As expected, the ipsilateral ureter and hemitrigone also are absent, but occasionally, a blind ending ureteric stump is seen. ^[6] The left kidney is more often involved than the right and males more than females in unilateral renal agenesis. ^[4] The left kidney was involved in our patient.

Associated congenital genital anomaly as in our patient is common; it is estimated to occur in 37-60% of females. ^[2],[3] A case of unilateral renal agenesis co-existing with bilateral cryptorchidism in an adult Nigerian was reported by Onwuchekwa et al. ^[7] In the Vater syndrome, unilateral renal agenesis is associated with other multiple anomalies such as ventricular septal defects, vertebral anomalies, anorectal atresia, tracheal and esophageal lesions. ^[6]

There are two main theories regarding the etiology of unilateral absence of the ovary. One is ischemia and atresia secondary to torsion of an ovarian pedicle during fetal or early post natal life. The second theory is that of a developmental anomaly. ^{[8],[9],[10],[11]} A case closely similar to the one presented was reported by Haydardedeoglu et al. ^[12] Their patient had left renal and ovarian agenesis with a unicornuate uterus. This was believed to have resulted possibly from an insult to the urogenital ridge of the affected side. ^[5] Schimke and King reported a family with three generation transmission with renal agenesis/dysgenesis and uterine anomaly, ^[13] suggesting a possible hereditary etiology.

Prenatal diagnosis of the solitary kidney by ultrasound is possible as early as 12-16 weeks gestation. ^[14] When found, the possibility of associated genital anomaly should be borne in mind.

Unilateral renal agenesis is usually asymptomatic and is compatible with longevity, ^[4] it is often discovered during imaging for other indications as in the case presented. Our patient had an ultrasound scan as part of the investigations for secondary infertility and abdominal mass. When a solitary kidney is discovered, the patient needs monitoring for urinary infection and obstructive uropathy. Avoidance of life style and activities that may endanger the single kidney is advocated.

Unilateral agenesis of the fallopian tube and ovary may increase the risk of infertility and/or premature ovarian failure if the remaining adnexal structures become diseased.

Conclusion

Congenital unilateral renal agenesis is rare. When found, the possibility of coexisting genital anomaly must be considered and investigated. Patient with solitary kidney needs counseling and monitoring to ensure that the single kidney does not get compromised in any way. An astute prenatal ultrasonography may assist in early detection of fetal organs.

References

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