Incidental Discovery of a Duplicated Ovary During Surgery for Acute Appendicitis in an Adolescent.

Acute right lower quadrant abdominal pain in adolescent women commonly raises suspicion for appendicitis; however, the differential diagnosis must also include gynecologic causes. Rare congenital anomalies can complicate the clinical picture and lead to unexpected intraoperative findings. We report the case of a 13-year-old girl presenting with right iliac fossa pain and minimal clinical signs. Laboratory and imaging studies supported a diagnosis of acute appendicitis. During an appendectomy, a duplicated right ovary was incidentally identified - an extremely rare anatomical anomaly with fewer than 30 cases documented in the literature. The appendectomy was completed, the internal genitalia were evaluated and repositioned anatomically, and the patient had an uneventful postoperative course, being discharged within 48 hours. Ovarian duplication is a rare embryologic anomaly that is usually asymptomatic and discovered incidentally. This case highlights the importance of maintaining a broad differential diagnosis in adolescent women presenting with acute abdominal pain and demonstrates the value of systematic intraoperative exploration. It also emphasizes the need for collaboration between pediatric surgeons and gynecologists when such anomalies are encountered. The discovery of rare congenital anomalies during routine surgical procedures underscores the importance of thorough intraoperative assessment and the limitations of preoperative imaging in pediatric emergencies. Documenting such cases adds to the medical literature, enhances awareness of uncommon anomalies, and informs future clinical management.