Management of VACTERL association with uterine anomaly: complex acute on chronic 10-year pelvic pain with haematometra

This case report presents a woman in her 20s with VACTERL association who presented with acute on chronic 10-year pelvic pain and haematometra. Initially, diagnostic imaging suspected a didelphic uterus with a dilated right horn on CT imaging. However, after physical examination and further imaging, further diagnosis of unicornuate uterus with non-communicating horn was noted. After years of expectant management, the patient began to experience severe malnutrition and metabolic derangements. After significant patient-centred discussions regarding pain relief, the patient was refractory to oral contraceptive pills and later started on GnRH antagonists. After the patient underwent an abdominal hysterectomy and right salpingectomy with resolution of pain symptoms. The case highlights the complexities of managing patients with multiple congenital anomalies, particularly VACTERL, and while not in the constellation of syndromes, gynaecological complications may arise due to common embryological origins. This case emphasises the importance of a multidisciplinary approach in challenging scenarios.