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. 2014;5(8):505-8.
doi: 10.1016/j.ijscr.2014.03.008. Epub 2014 Jun 12.

Diagnostic laparoscopy in a twelve year old girl with right iliac fossa pain: A life changing diagnosis of complete androgen insensitivity syndrome

Babak Meshkat  1 , Melania Matcovici  2 , Claire Buckley  2 , Muhammad Salama  2 , Haresh K Perthiani  2
Affiliations

Diagnostic laparoscopy in a twelve year old girl with right iliac fossa pain: A life changing diagnosis of complete androgen insensitivity syndrome

Babak Meshkat et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Right iliac fossa (RIF) pain is one of the most common presenting complaints faced by general surgeons in the emergency department. Correct diagnosis and appropriate surgical intervention can often pose a challenge.

Presentation of case: A 12-year-old girl presented to the emergency department with a four day history of initially central acute abdominal pain, now localised in the RIF. During laparoscopy, the following findings were made: macroscopically dilated appendix, right and left gonads at the internal opening of the inguinal canal, empty pelvis with a rudimentary uterus on the right side. No evidence of fallopian tubes or connection of uterus to the vagina and broad based, non-inflamed Meckel's diverticulum. An incidental diagnosis of complete androgen insensitivity syndrome was made.

Discussion: Androgen insensitivity syndrome (AIS) is a disorder of hormone resistance characterised by a female phenotype in an individual with an XY karyotype and testes producing age-appropriate normal concentrations of androgens.

Conclusion: This case report highlights the advantage of laparoscopy as a diagnostic and treatment tool in a twelve year old girl with multiple intra-abdominal findings. While the ultimate diagnosis responsible for her symptom of RIF pain was acute appendicitis, the additional diagnosis of CAIS and incidental Meckel's would have otherwise likely gone undetected.

Keywords: Complete androgen insensitivity syndrome; Laparoscopy; Right iliac fossa pain.

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Figures

Fig. 1
Fig. 1
Right gonad.
Fig. 2
Fig. 2
Left gonad.
Fig. 3
Fig. 3
Empty pelvis.
Fig. 4
Fig. 4
Rudimentary uterus on right side.
Fig. 5
Fig. 5
Broad based, non-inflamed Meckel's diverticulum.
See this image and copyright information in PMC

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