scispace - formally typeset

Journal ArticleDOI

Hysteroscopy- and laparoscopy-based diagnosis and treatment of girls with unbroken hymen with an obstructing uterine septum: two case reports

Songshu Xiao1, Min Xue1, Yajun Wan1, Yueran Li1, Dabao Xu1 
24 Jun 2014-Journal of Medical Case Reports (BioMed Central)-Vol. 8, Iss: 1, pp 222-222

TL;DR: Virgo intacta women with obstructing uterine septum could be treated with electrosurgical obstructing uterusine sePTum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.

AbstractObstructing uterine septum is a rare uterine malformation. Patients with obstructing uterine septum are usually treated with laparouterotomy, causing obvious injury to both the uterus and body of the patients. Therefore, using the natural channel of the vagina is undoubtedly the best way to carry out the surgery. However, obstructing uterine septum usually occurs in puberty in girls without a history of sexual intercourse, thus iatrogenic damage to the hymen during the diagnosis and treatment cannot probably be avoided. However, Chinese people traditionally tend to use hymen intactness as a standard to judge whether an unmarried woman is chaste. Therefore, in China, to protect the hymen from damage during hysteroscopic diagnosis and treatment is of special significance for girls and women with unbroken hymens. None of the previously reported cases were treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy. Case 1 patient was a virgo intacta 13-year-old Chinese girl. She was admitted due to an 8-day post-menstruation lower abdominal pain. With the guidance of B-ultrasound, we observed a 30mm×20mm mixed echogenicity mass in her uterine cavity. Case 2 patient was a virgo intacta 14-year-old Chinese girl. She was admitted to our hospital more than 6 months after secondary dysmenorrhea and 6 days after B-ultrasound-diagnosed uterine malformations. We observed a 30mm×25mm mixed echoic area in her uterine cavity with the guidance of B-ultrasound. Both patients were surgically treated without hymen damage with B-ultrasound-guided combined therapy of hysteroscopy and laparoscopy. A needle electrode with an 8mm diameter was placed into their uterine cavities under hysteroscopy. After obstructing uterine septum removal, their uterine cavities showed normal morphology. To protect their hymens, misoprostol was placed into their rectums to soften their cervices, so that the hysteroscope could be inserted into their cavities without damaging their hymens. Virgo intacta women with obstructing uterine septum could be treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy.

Topics: Uterine septum (65%), Uterine malformation (62%), Uterine cavity (62%), Hymen (57%), Hysteroscopy (55%)

...read more

Content maybe subject to copyright    Report

Citations
More filters

Journal ArticleDOI
01 Feb 2021
Abstract: Bicornuate, septate, or arcuate uterus are common mullerian anomalies which account for 85% of such anomalies. A rare mullerian anomaly is an asymmetric septate uterus with hematometra, reported first by Robert H. A complete septum divides the uterine cavity into one non-communicating hemi-cavity with hematometra, while menstruation occurs from the other hemi-cavity. This may be misdiagnosed as a unicornuate uterus with a non-communicating horn with hematometra. Suspicion of this anomaly, diagnosis, and its management including reproductive outcomes poses a challenge as the anomaly itself is rarely reported. We present a 19-year-old girl with worsening dysmenorrhea due to Robert’s uterus who was managed by resection of the uterine septum and unification of the two hemi-cavities. Seven years later, she underwent in vitro fertilization, had an uncomplicated pregnancy, and delivered by caesarean section at term. Until date, only two successful pregnancy outcomes were reported with Robert’s uterus. With advances in imaging modalities and minimally invasive surgery, diagnosis of Robert’s uterus is early, and hysterolaparoscopy has now become the gold standard therapy.

References
More filters

Journal ArticleDOI
TL;DR: A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy.
Abstract: Roberts uterus or asymmetric septate uterus is an uncommon uterine mullerian anomaly first reported by Robert in 1970. It has two uterine cavities with one being blind causing menstrual retention. Till date only 17 such cases have been reported in literature. A unique congenital mullerian anomaly; asymmetric septate uterus with noncommunicating right sided hemicavity and haematometra a normal extrauterine morphology with right ovarian maldescent and stage III endometriosis was diagnosed on laparotomy. (excerpt)

23 citations


"Hysteroscopy- and laparoscopy-based..." refers background in this paper

  • ...To date, only several studies have been carried out on OUS [1-5]....

    [...]


Journal ArticleDOI
TL;DR: An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death with suspicion of non-communicating uterine horn with bicornuate uterus.
Abstract: An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert's uterus). Hysterotomy and ipsilateral tubal ligation were performed.

22 citations


"Hysteroscopy- and laparoscopy-based..." refers background in this paper

  • ...To date, only several studies have been carried out on OUS [1-5]....

    [...]


Journal ArticleDOI
TL;DR: Hysteroscopy without damaging the intact hymen is feasible and helpful for the diagnosis in the treatment of pathologic endometrial changes in women.
Abstract: Study objective We perform hysteroscopy in 14 women for the diagnosis and treatment of pathologic changes in the uterine cavity of women with an intact hymen. All hysteroscopies were successfully carried out with the hymen intact and the therapeutic results were excellent. Design Retrospective study. Setting University-affiliated hospital, department of obstetrics and gynecology. Patients Fourteen unmarried women who underwent hysteroscopy on the condition of keeping the hymen intact. Interventions Hysteroscopy was used for the diagnosis and treatment of pathological changes in the uterine cavity of women with an intact hymen. Measurements and main results All 14 hysteroscopies were successfully carried out with the hymen intact, and the therapeutic results were excellent. Conclusion Hysteroscopy without damaging the intact hymen is feasible and helpful for the diagnosis in the treatment of pathologic endometrial changes in women.

21 citations


"Hysteroscopy- and laparoscopy-based..." refers background or methods in this paper

  • ...4mg misoprostol was placed into her rectum 3 hours before the surgery to soften her cervix [6]....

    [...]

  • ...In the Chinese culture, the hymen is particularly important for young women [6]....

    [...]


Journal ArticleDOI
TL;DR: Pediatric surgeons and gynecologists should be aware of this atypical obstructive Müllerian malformation and its management in order to avoid inappropriate management of these young patients.
Abstract: Background Robert's uterus is an asymmetric septate uterus. This malformation is very rare, particularly in the pediatric age group. Radiologic findings could be surprising, but are very specific. We report here a representative case. Case A 15-year-old patient complaining of recurrent abdominal cramps consulted the emergency department for evaluation of acute pain. Radiologic studies showed a circular lesion that had developed within the posterior wall of the uterus. The patient underwent surgery for a suspected Robert's uterus and an endometriectomy of the blind cavity was performed. There was no communication between the blind cavity and the ipsilateral fallopian tube. Summary and Conclusion Pediatric surgeons and gynecologists should be aware of this atypical obstructive Mullerian malformation and its management in order to avoid inappropriate management of these young patients.

20 citations


"Hysteroscopy- and laparoscopy-based..." refers background in this paper

  • ...To date, only several studies have been carried out on OUS [1-5]....

    [...]


Journal ArticleDOI
TL;DR: Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum and is associated with easier recovery and less implication for future fertility.
Abstract: Objective To report a case of complete obstructing uterine septum repaired in a minimally invasive manner by operative hysteroscopy under laparoscopic guidance. A complete obstructing uterine septum is a rare congenital abnormality. To date, management of such abnormalities has traditionally been by metroplasty. Design Case report and review of the literature. Setting Pediatric and adolescent gynecology service at a tertiary care hospital. Patient(s) A 16-year-old nulligravid presented with severe, persistent dysmenorrhea and a history of significant endometriosis. Imaging initially suggested a functional, noncommunicating uterine horn, but magnetic resonance imaging review confirmed a complete obstructing septate uterus. Intervention(s) The patient was managed by menstrual suppression until the time of surgery. The septum was resected by operative hysteroscopy under laparoscopic guidance. The procedure was without complication. Main Outcome Measure(s) The patient recovered well and resumed spontaneous menses without dysmenorrhea. Result(s) A second-look hysteroscopy 4 months later confirmed patency of the previously obstructed side and allowed the opportunity to complete the resection of the septum. Conclusion(s) Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum. Hysteroscopy is less invasive than traditional metroplasty and is associated with easier recovery. Additionally, there is no uterine scar and thus less implication for future fertility. Further series of such procedures are required to offer greater experience and proof of safety of this approach.

15 citations


"Hysteroscopy- and laparoscopy-based..." refers background in this paper

  • ...For rare malformations, compared with the conventional open surgery and laparoscopic plastic surgery, our transvaginal surgical therapy has several advantages as follows: 1) uterine scar and trauma can be avoided; 2) the removal area and depth can be firmly determined to maximally recover the uterine cavity; and 3) the appearance and function of the uterine cavity can be protected to reduce the risk of uterine pregnancy rupture [7]....

    [...]

  • ...OUS is a rare uterine malformation characterized by the moving of the intrauterine septum towards one side, which separates the uterine cavity into two, and the hemorrhage at the latching side can cause secondary dysmenorrhea [7]....

    [...]