Multiple congenital intra-abdominal abnormalities
4 days left iliac fossa and suprapubic pain and vomiting. Bowels not opened for five days. Complex past medical history, including small bowel injury during caesarean section with multiple abscesses. Recurrent abscess? Fistula? Obstruction?
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A tubular fluid-filled structure within the left iliac fossa measures up to 2.5 centimetres, and is suspicious for a dilated fallopian tube. A 4 x 3 cm cyst is seen within the adjacent left ovary. No abnormality of the uterus or right ovary.
Crossed fused ectopia of the left kidney is noted. Intestinal malrotation, with left-sided colon and right-sided small bowel. No evidence of volvulus. Duplicate inferior vena cava, with persistent left IVC draining to the left renal vein. There is also communication between left and right IVC at the level of the right common iliac artery.
Rectal faecal loading noted. A broad necked small ventral hernia (incisional) contains bowel, but without evidence of obstruction or incarceration.
No focal abnormality of the liver, spleen, pancreas, adrenals or gallbladder. The visualised lung bases are clear.
Dilation of the left fallopian tube is concerning for left tubo-ovarian abscess in this setting. The differential is sterile hydrosalpinx. Gynaecological review and pelvic ultrasound is suggested.
Multiple congenital abnormalities as described.