True hermaphrodism presenting as pelvic abscess.

CASE REPORT A 29-year-old patient presented with fever, abdominal pain, and pyuria since 8 days earlier. There was no history of episodic hematuria. The patient was reared as a male and appeared to be a phenotypically male with short stature and male pattern of body hair. Local examination showed suprapubic fullness with distal penile hypospadias and an empty left scrotal sac. Routine investigations showed moderate anemia and a total leukocyte count of 9 × 109/L. Urine examination revealed innumerable pus cells, and culture showed presence of Escherichia coli. Abdominal ultrasonography showed a 13 × 7-cm, thick-walled encysted lesion in the midline pelvic area, displacing posterior wall of the bladder anteriorly and extending to the left iliac fossa. Computed tomography revealed a large loculated fluid collection with thick walls and septations in the retrovesical plane including left lateral pelvic wall, which was highly suggestive of a large abscess. The patient underwent exploratory laparotomy in order to drain the retrovesical pus, which revealed a unicornuate uterus ending in a blind vaginal pouch along with left fallopian tube and ovary. The vaginal pouch was filled with pus and had a fistulous connection with the bladder anteriorly. Hysterectomy with left salpingo-oophorectomy was performed along with ligation and excision of the fistulous tract between the bladder and the vaginal pouch and excision of the vaginal pouch.