Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Viktoriya Salgalova, OMS-III; Mallory Barlow, OMS-III; Karlie Pinion, OMS-II; Savannah Newell, PhD VCOM-Louisiana 69 DELAYED DIAGNOSIS OF UTERUS DIDELPHYS WITH ASSOCIATED VAGINAL SEPTUM: A CASE REPORT

Benjamin Kaplan, OMS-III 1 ; Meyer Kaplan, MD 2 1 VCOM-Louisiana; 2 Department of General Surgery, Rapides Regional Medical Center, Alexandria, Louisiana 70 LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM PRESENTING AS ACUTE APPENDICITIS IN A 73-YEAR-OLD MAN

Context: Uterus didelphys is a rare congenital defect, present in approximately 0.5 to 5.0% of the population, that arises from abnormal embryological development of the Müllerian ducts and is characterized by the duplication of the uterine cavity and the cervix. This case highlights delayed recognition and the importance of multidisciplinary management to address the significant reproductive and psychological burden of this anomaly. Report of Case: This case describes a woman of reproductive age with a history of irregular menses and polycystic ovary syndrome who presented for routine gynecological care and infertility counseling. The initial pelvic examination and Pap smear were unremarkable. Pelvic ultrasound identified uterine and cervical duplication, but the patient reported limited counseling and was reassured that the congenital anomaly would not affect fertility. The patient continued to seek care from multiple providers due to concerns about infertility and persistent symptoms with repeated dismissal and delays in care. She was eventually referred to a gynecologist who was determined to provide thorough care to address the patient’s

concerns. This doctor was able to identify an associated vaginal septum during the initial pelvic examination, and surgical intervention was discussed. Further fertility evaluation included an assessment of tubal patency using hysterosalpingogram, which demonstrated patent fallopian tubes. In addition, the patient attempted ovulation induction with letrozole and intrauterine insemination which resulted in pregnancy that ended in early miscarriage. The patient subsequently underwent surgical resection of the vaginal septum. After another early miscarriage post-operatively, the patient elected to pause fertility treatment. Conclusions: A literature review was conducted using PubMed with search terms “uterus didelphys,” “infertility,” and “Müllerian duct anomalies.” According to previous studies, uterus didelphys is associated with increased risk of infertility, miscarriage, and other obstetric complications, especially with the presence of vaginal septa [1, 2]. Additional studies suggest that surgical intervention may improve reproductive outcomes and quality of life [3]. This case demonstrates the diagnostic challenges associated with uterus didelphys

and emphasizes the importance of early recognition and comprehensive evaluation. It also highlights the psychological burden associated with delayed diagnosis and dismissal of patient concerns, reinforcing the need for multidisciplinary, patient-centered approaches in the management of uterine anomalies.

Context/Impact: Low-grade appendiceal mucinous neoplasms (LAMNs) are rare appendiceal tumors that may present with nonspecific symptoms and are frequently misdiagnosed as acute appendicitis. Recognition of this entity is clinically important due to its potential for peritoneal dissemination and pseudomyxoma peritonei. Report of Case: A 73-year-old man presented with acute right lower quadrant abdominal pain associated with right lower quadrant pain without fever. Physical examination demonstrated focal right lower quadrant tenderness with guarding. Laboratory evaluation revealed absent leukocytosis. Computed tomography of the abdomen and pelvis showed an enlarged appendix with minimal periappendiceal fat stranding and without evidence of abscess or free fluid. The patient underwent laparoscopic appendectomy without intraoperative complication. Gross examination revealed a distended, mucin-filled appendix without rupture. Histopathologic analysis demonstrated a mucinous epithelial neoplasm with low-grade cytologic atypia and a pushing growth pattern, consistent with low-grade

appendiceal mucinous neoplasm. Surgical margins were negative, and there was extra appendiceal mucin present. The postoperative course was uncomplicated, and the patient was discharged in stable condition. Subsequent multidisciplinary review guided postoperative surveillance planning. Conclusion: LAMNs are uncommon and often diagnosed incidentally following appendectomy for presumed appendicitis, particularly in older patients in their 6th decade of life. Literature review was conducted using PubMed and Google Scholar with search terms including “low-grade appendiceal mucinous neoplasm,” “appendiceal mucocele,” and “appendicitis mimic.” Consistent with published data, this case demonstrates that LAMN can present without distinctive preoperative features and underscores the importance of routine histopathologic evaluation of appendectomy specimens. Appropriate staging, margin assessment, and individualized follow-up are essential to reduce the risk of disease progression and peritoneal spread.

83

82

2026 Research Recognition Day