Hysteroscopy- and laparoscopy-based diagnosis and treatment of girls with unbroken hymen with an obstructing uterine septum: two case reports
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.
Abstract: Obstructing 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.
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01 Feb 2021
TL;DR: In this paper, a 19-year-old woman with worsening dysmenorrhea due to Robert's uterus was managed by resection of the uterine septum and unification of the two hemi-cavities.
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.
1 citations
TL;DR: The case of a 19 year old woman with Robert’s uterus, an extremely rare variety of congenital mullerian duct anomaly, was presented, where the imaging modalities failed to diagnose the case.
Abstract: Roberts uterus is an extremely rare variety of congenital mullerian duct anomaly. It is also known as asymmetric septate uterus. The uterine septum is complete and fused with uterine wall on one side dividing the cavity into two: one non-communicating and another communicating with cervix. Regular menstrual flow occurs from the communicating cavity. At the same time, obstruction to menstrual flow in one cavity results in formation of hematometra, sometimes hematosalpinx and endometriosis. Presenting symptoms are severe dysmenorrhea and abdominal pain.Imaging modalities like three dimensional ultrasonography or magnetic resonance imaging are useful in diagnosing the mullerian duct anomaly. Traditionally the condition has been treated by laparotomy followed by complete excision of the obstructed one sided cavity. In recent years, incision of septum has been done by hysteroscopy, resulting in a uterine cavity with better reproductive outcome. Here presented the case of a 19 year old woman with Robert’s uterus. The imaging modalities failed to diagnose the case. The anomaly was explored by laparoscopy and hysteroscopy followed by laparotomy. The obstructed hemi-cavity had thick altered blood. It was obliterated following excision of endometrium. The woman was relieved of pain thereafter.
Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 125-129
References
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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.
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]....
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...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]....
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Journal Article•
TL;DR: Robert's uterus or asymmetric septate uterus is a rare malformation that presents with two cavities, one of which is blind: the blind cavity, on the right side of the septum, contained retained secretions.
Abstract: Robert's uterus or asymmetric septate uterus is a rare malformation. It presents with two cavities, one of which is blind. The authors report an original case: the blind cavity, on the right side of the septum, contained retained secretions. The embryologic and physiopathologic mechanism of this anomaly still are to be discussed.
9 citations
"Hysteroscopy- and laparoscopy-based..." refers background in this paper
...To date, only several studies have been carried out on OUS [1-5]....
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