Persistent undeveloped mesonephric duct (a case report).
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Bombay, India., India
S V Parulekar
Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Parel, Bombay, India.
The mesonephric duct may fail to develop, resulting in congenital absence of the kidney and ureter. A unique case of persistence of the mesonephric duct without development into the kidney and ureter is presented.
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Parulekar S V. Persistent undeveloped mesonephric duct (a case report). J Postgrad Med 1990;36:54-5
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Parulekar S V. Persistent undeveloped mesonephric duct (a case report). J Postgrad Med [serial online] 1990 [cited 2021 Mar 4 ];36:54-5
Available from: https://www.jpgmonline.com/text.asp?1990/36/1/54/869
Congenital absence of a kidney and its ureter is not an uncommon malformation. It is due to failure of the mesonephric duct to develop. However in such cases the duct is not seen. Gartner's duct, a vestigeal remnant of the mesonephric duct exists in an adult woman, but only in presence of normal development of the mesonephric duct. A case of persistent mesonephric duct without any development is presented.
Mrs. SL, 56 year old woman presented for management of a third degree uterine prolapse with cystocele and rectocele. After investigations for fitness for surgery, whose reports were normal, she was subjected to vaginal hysterectomy with vault suspension, anterior colporrhaphy, and posterior colpo-perineorrhaphy under general anaesthesia.
After making a circumferential incision on the vaginal mucosa, the bladder was dissected off the front of the cervix. It was then noticed that a 4 mm wide tube had been cut across on the right side of the cervix. The end of the tube at the cervical end was blind. A ureteric catheter could be passed up the tube for about 10 cm. Vaginal hysterectomy was completed, keeping the tube laterally. The urinary bladder was opened suprapubically extraperitoneally. It was found that there was only the left ureter, and the inter-ureteric bar was present only on the left side of the mid-line. The tubular structure with a ureteric catheter inside was exposed by extraperitoneal dissection on the right side. It was found to ascend extraperitoneally up to the level of pelvic inlet and above, but further dissection was not done, as it would serve no purpose. An ultrasonic scan confirmed absence of the right kidney. A segment of the tubular structure was removed, and the lower end was doubly ligated and closed off. Anterior colporrhaphy, vault suspension by modified Heaney's technique, and posterior colpo-perineorrhaphy were carried out. The urinary bladder was closed in two layers with No. 3/0 chromic catgut after the right ureter was catheterized and the ureteric catheter was taken out through the urethra. Abdomen was closed in layers. The patient made an uneventful recovery, the ureteric catheter being removed after 4 days, and Foley's catheter after 7 days. Microscopy of the tube showed a fibrous walled tube lined by cuboidal epithelium.
The anomalous tubular structure coursing down the pelvic wall extraperitoneally was along the course of the Gartner's duct in its lower portion, and along the course of the ureter in its upper portion. There was no development of the ureter and kidney on the right side, where this tube was found. The tube was well developed, and lined by cuboidal epithelium. Thus it could have been only the mesonephric duct grown, but not developed, as it should have done. Such an anomaly has not been reported in the literature before.
The mesonephric duct may rarely grow but not develop into the ureter in an adult. Such an anomaly has to be associated with ipsilateral absence of the kidney, which develops from the metanephros where it comes into contact with the mesonephric duct.
I thank the Dean of King Edward Memorial Hospital and Seth GS Medical College for permitting me to publish hospital data.
Mattingly RF. TeLinde's Operative Gynaecology. 5th edition. Philadelphia, Toronto, Tokyo: JB Lippincott Company; 1977, pp 502-509.|
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