275Urology Journal    Vol 5    No 4    Autumn 2008

Case Report

True Hermaphrodism Presenting as Pelvic Abscess
Sushant Wadhera, Nitesh Patidar, Sudershan Odiya, Arvind Ghanghoria,  
Rajkumar Mathur, Ashish Kumar Gupta

Urol J. 2008;5:275-6. 
www.uj.unrc.ir

Keywords: true hermaphroditism, 
genitalia, mosaicism, differential 

diagnosis 

Department of Surgery, MGM 
Medical College and MY Hospital, 

Indore, Madhya Pradesh, India

Corresponding Author:
Sushant Wadhera, MBBS, MS

Department of Surgery, MY 
Hospital, Indore, Madhya, Pradesh, 

India
Tel: +91 989 363 6012

Fax: +91 731 270 2088
E-mail: sushantwadhera@gmail.

com

Received October 2007 
Accepted January 2008

INTRODUCTION
True hermaphroditism is a rare 
form of ambiguous genitalia 
characterized by simultaneous 
presence of both normal male and 
female gonadal tissues in a same 
patient.(1,2) Although uncommon, 
true hermaphroditism has been 
reported in more than 400 
individuals, to date.(3) We report a 
hermaphrodite patient presenting 
with a 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.

Postoperative hormonal assay was 
carried out which showed a raised 
serum estradiol (66.5 pg/mL)  
and luteinizing hormone (13.2 
mIU/mL) with a progesterone 
(0.9 ng/mL), testosterone (541.4 
ng/dL), and follicle-stimulating 
hormone (15.49 mIU/mL) within 
the reference range. Chromosomal 
analysis using GTC banding 
revealed normal male karyotype 
of 46XY in all cells analyzed. The 
operative specimen was sent for 
histopathological examination and 
revealed uterous endometrium 
and ovarian and vaginal tissue 
with diffused inflammatory cell 
infiltration.



True Hermaphrodism as Pelvic Abscess—Wadhera et al

276 Urology Journal    Vol 5    No 4    Autumn 2008

DISCUSSION
There are 4 major groups of ambiguous 
genitalia: female pseudohermaphroditism, 
male pseudohermaphroditism, mixed gonadal 
dysgenesis, and true pseudohermaphroditism. In 
true pseudohermaphroditism, 4 types of gonadal 
distribution are seen. The most common is the 
presence of bilateral ovotestes. Other variants 
include ovary on one side and ovotestis on the 
other side, testis on one side and ovotestis on the 
opposite side, and presence of testis on one side 
and ovary on the other side, which is the rarest 
form.(2,4,5) The most common cytogenetic pattern 
of these patients is genotypic female (46XX). All 
forms of mosaicism are next in frequency and 
the rarest are genotypic males (46XY). Gonadal 
tumors occur with an incidence of 4% among 
those with 46XX karyotype and up to 10% in 
those with 46XY and 46 XX/XY mosaicism.(6)

Combination of 46XY genotype with the 
presence of the right testis and the left ovary 
makes this case the rarest of rare cases of true 
hermaphroditism. To our best knowledge, this is 
the first case of 46XY true male hermaphroditism 

with a functioning testis on one side and a 
contralateral functioning ovary presenting as a 
pelvic abscess.

CONFLICT OF INTEREST
None declared.

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True hermaphroditism: genetic variants and clinical 
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3. Malik V, Gupta D, Gill M, Salvi AL. Seminoma in a 
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4. Aaronson IA. True hermaphroditism. A review of 41 
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function. Br J Urol. 1985;57:775-9.

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