1
|
Chen M, Yang X, Zhang B, Fu J, Lan Y, Chi Y. Diagnosis and treatment of Robert's uterus combined with transverse uterine septum: a case report and review of the literature. Front Med (Lausanne) 2024; 11:1434957. [PMID: 39156687 PMCID: PMC11327016 DOI: 10.3389/fmed.2024.1434957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/03/2024] [Indexed: 08/20/2024] Open
Abstract
Background Robert's uterus combined with transverse uterine septum is a rare uterine malformation. Only one case has been reported to date, and it is challenging to diagnose and treat. Case presentation Here we report the case of a 19-year-old female had undergone multiple treatments at a previous hospital for primary amenorrhea and periodic lower abdominal pain, with the cause remaining unclear. Ultrasonography and magnetic resonance imaging conducted at our hospital displayed the presence of uterine dysplasia with an incomplete septum. Following a multidisciplinary discussion, a preliminary diagnosis of Robert's uterus combined with transverse uterine septum was made. Following this, laparoscopic exploration and ultrasound-guided hysteroscopic metroplasty were performed. The patient experienced periodic menstruation postoperatively and did not manifest periodic lower abdominal pain. Conclusion Robert's uterus combined with transverse uterine septum is a very rare uterine malformation, with hysteroscopic metroplasty being the preferred surgical option. Nevertheless, preoperative diagnosis is extremely difficult, and there are also many difficulties in the surgical process. This case outlines the diagnostic and treatment process of a patient with Robert's uterus and transverse uterine septum. It is of great significance to fill the gap in clinical diagnosis and treatment of this special uterine malformation.
Collapse
Affiliation(s)
- Mingqian Chen
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Xiaoyu Yang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Bin Zhang
- Department of Ultrasound, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Jialiang Fu
- Department of Radiology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Yi Lan
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| | - Yugang Chi
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University (Chongqing Health Center for Women and Children), Chongqing, China
| |
Collapse
|
2
|
Gulino FA, Occhipinti S, Ettore C, Incognito GG, Russo E, Cannone FG, Ettore G. Challenges in the diagnosis and management of Robert's uterus: Systematic review and case presentation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:619-628. [PMID: 38549367 DOI: 10.1002/jcu.23675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 06/15/2024]
Abstract
Robert's uterus is a rare Müllerian duct anomaly (MDA) characterized by complete asymmetric septum dividing uterine cavity into two non-communicating parts. This study offers insights into diagnosing and management of this condition in a young patient, and a systematic literature review. The review included 19 studies from 2013 to 2023. 11.4% of women reported a history of miscarriage and 5.7% primary infertility. Dysmenorrhea was the most frequent symptom (54.3%), and 14.3% of patients had a coexisting endometriosis. The surgical interventions most commonly combine laparoscopic and hysteroscopic techniques. Robert's uterus requires heightened clinical awareness for early diagnosis, particularly in young women.
Collapse
Affiliation(s)
| | - Sara Occhipinti
- Department of Obstetrics and Gynaecology, ARNAS "Garibaldi" Hospital, Catania, Italy
| | - Carla Ettore
- Department of Obstetrics and Gynaecology, ARNAS "Garibaldi" Hospital, Catania, Italy
| | | | - Emanuele Russo
- Department of Obstetrics and Gynaecology, ARNAS "Garibaldi" Hospital, Catania, Italy
| | | | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, ARNAS "Garibaldi" Hospital, Catania, Italy
| |
Collapse
|
3
|
Schubert M, Tihon A, Andresen K, Ruchay Z, Farrokh A, Maass N, Elischer P, Longardt AC, Tesch K, Lebenatus A, Krüger M, Alkatout I. Peripartal management of dichorial twin pregnancy in a bicornuate bicollis uterus: a case report and review of the literature. J Med Case Rep 2024; 18:196. [PMID: 38643176 PMCID: PMC11032606 DOI: 10.1186/s13256-024-04506-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/12/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The management of a pregnancy in a bicornuate uterus is particularly challenging. A bicornuate uterus is a rare occurrence and a twin pregnancy in a bicornuate uterus even more rare. These pregnancies call for intensive diagnostic investigation and interdisciplinary care. CASE PRESENTATION We report on a 27-year-old European woman patient (gravida I, para 0) with a simultaneous pregnancy in each cavity of a bicornuate bicollis uterus after embryo transfer. The condition was confirmed by hysteroscopy and laparoscopy. Several unsuccessful in vitro fertilization (IVF) attempts had been performed earlier before embryo transfer in each cornus. After a physiological course of pregnancy with differential screening at 12 + 6 weeks and 22 + 0 weeks of gestation, the patient presented with therapy-resistant contractions at 27 + 2 weeks. This culminated in the uncomplicated spontaneous delivery of the leading fetus and delayed spontaneous delivery of the second fetus. DISCUSSION Only 16 cases of twin pregnancy in a bicornuate unicollis uterus have been reported worldwide and only 6 in a bicornuate bicollis uterus. The principal risks in such pregnancies are preterm labor, intrauterine growth restriction, malpresentation and preeclampsia. These typical risk factors of a twin pregnancy are greatly potentiated in the above mentioned setting. CONCLUSION A twin pregnancy in the presence of a uterine malformation is rare and difficult to manage. These rare cases must be collected and reported in order to work out algorithms of monitoring and therapy as well as issue appropriate recommendations for their management.
Collapse
Affiliation(s)
- Melanie Schubert
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany.
| | - Anastasia Tihon
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, 97080, Würzburg, Germany
| | - Kristin Andresen
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Zino Ruchay
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - André Farrokh
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Philipp Elischer
- Department for Pediatrics and Adolescent Medicine I, Neonatology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Ann Carolin Longardt
- Department for Pediatrics and Adolescent Medicine I, Neonatology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Karolin Tesch
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Annett Lebenatus
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, 24105, Kiel, Germany
| | - Magret Krüger
- Center for Operative Gynecology, Park Clinic, 24116, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, 24105, Kiel, Germany.
| |
Collapse
|
4
|
Mahey R, Cheluvaraju R, Kumari S, Kachhawa G, Kumari A, Rajput M, Bhatla N. Robert's Uterus versus Juvenile Cystic Adenomyoma - Diagnostic and Therapeutic Challenges - Case Report and Review of Literature. J Hum Reprod Sci 2023; 16:79-86. [PMID: 37305779 PMCID: PMC10256944 DOI: 10.4103/jhrs.jhrs_10_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/13/2023] Open
Abstract
This case report highlights the diagnostic dilemma and therapeutic challenges encountered while managing adolescent girls with progressive dysmenorrhoea and management of Robert's uterus. Two girls aged 20 years and 13 years presented with severe progressive dysmenorrhoea. In the first case, laparoscopy revealed juvenile cystic adenomyoma (JCA) of 3 cm × 3 cm on the left side anteroinferior to the round ligament. Laparoscopic resection of the lesion was done, and histopathology revealed features of adenomyosis. In the second case, there was a globular enlargement of the right half of the uterine body with round ligament and adnexa attached to the lesion (Robert's uterus). In view of severe symptoms, complete resection of the lesion and partial resection of hemi-uterus was done, followed by myometrial defect closure. Both cases were initially diagnosed as JCA, and the final diagnosis was made on laparoscopy. Both girls had complete symptomatic relief from the next menstrual cycle and have been under follow-up for 24 months and 18 months, respectively. Due to the rarity of conditions, Robert's uterus and JCA are usually misdiagnosed with each other or with other Mullerian anomalies such as a non-communicating unicornuate uterus. Radiologists and clinicians should be aware of these different pathologies causing similar symptoms. Understanding the pathology, early diagnosis, timely referral and correct surgical procedure are emphasised to improve reproductive outcomes.
Collapse
Affiliation(s)
- Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohitha Cheluvaraju
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Supriya Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Rajput
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
5
|
Liu Y, Hou C, Zhou Y. Ultrasound combined with hysteroscopy for optimum treatment of Robert’s uterus: a case report and a review. BMC Womens Health 2022; 22:334. [PMID: 35934693 PMCID: PMC9358804 DOI: 10.1186/s12905-022-01903-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Rbert’s uterus, also known as asymmetric septate uterus, is a rare genital malformation first reported by Dr. Robert in 1970. Robert’s uterus is characterized by a septate uterus with a blind hemicavity and an intact external fundus. According to some reports, Robert’s uterus was typically managed by laparoscopic uterine resection of a hemicavity, laparoscopic endometrectomy, and even hysterectomy. Considering that fertility preservation is important in young patients, we recommend ultrasound-guided hysteroscopic septum resection as an optimum treatment for Robert’s uterus. Case presentation Herein is described a clinical case of Robert’s uterus in a 15-year-old girl who was misdiagnosed for primary dysmenorrhea in the beginning. Magnetic resonance imaging (MRI) and 3-dimensional (3D) ultrasound identified an asymmetrical uterine septum. The patient was treated using ultrasound-guided hysteroscopic treatment without laparoscopy. The surgical procedure lasted less than an hour, and the symptoms of dysmenorrhea were relieved during a six months follow-up. Conclusions Ultrasound-guided hysteroscopic septum resection is the preferred treatment for Robert’s uterus.
Collapse
|
6
|
Hong XY, Ding B, Shen Y. Laparo-Endoscopic Single Site Combined With Hysteroscopy to Diagnose and Treat Robert’s Uterine Malformation: A Case Report. Front Surg 2022; 9:926935. [PMID: 35774386 PMCID: PMC9237520 DOI: 10.3389/fsurg.2022.926935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Asymmetric septate uterus, commonly known as Robert’s uterus, is an exceedingly rare uterine malformation described for the first time in 1970 by Robert H. Currently, surgery is the therapy of choice for Robert’s uterus, with surgical choices ranging from laparotomy to minimally invasive surgery. In this paper, we reported that a 14-year-old girl with primary dysmenorrhea that gradually worsened three months after menarche had surgery after many imaging evaluations, and that the intraoperative diagnosis was Robert’s uterus. The diagnostic and therapeutic laparo-endoscopic single site(LESS) combined with hysteroscopy surgery for Robert’s uterine abnormality was shown via a step-by-step presentation of the method accompanied by narrated video footage. During the ten-month postoperative follow-up period, the patient had monthly recurrences with normal menstrual volume and no dysmenorrhea, demonstrating that as a minimally invasive treatment, LESS combined with hysteroscopy surgery is a successful methodfor diagnosing and treating this specific malformation.
Collapse
Affiliation(s)
- Xin-Yi Hong
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, China
| | - Bo Ding
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine,Southeast University, Nanjing, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine,Southeast University, Nanjing, China
- Correspondence: Yang Shen
| |
Collapse
|
7
|
Intrauterine adhesions combined with Robert's uterus: a case report and literature review. Arch Gynecol Obstet 2022; 306:1069-1075. [PMID: 35486154 DOI: 10.1007/s00404-022-06574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To summarize the clinical characteristics and surgical option of Robert's uterus. METHODS We reported a rare case of Robert's uterus with severe uterine adhesion with successive laparoscopic and hysteroscopic surgery. To our knowledge, such a case has not been reported previously. We also performed a systematic literature review from the PubMed, Embase, and Cochrane databases. RESULTS Our patient with Robert's uterus with severe uterine adhesions was successfully treated with hysteroscopic septal resection and hysteroscopic adhesiolysis, and the intractable dysmenorrhea disappeared after the hysteroscopic septal resection. In our study, we analyzed the selected 22 reported cases, 10/22 cases (45.5%) were diagnosed before age 20; 20/22 cases (90.91%) experienced dysmenorrhea, 19/22 cases (86.36%) were with hematometra. 5/22 cases (22.73%) underwent re-operation or a third surgery before diagnosis and management. CONCLUSION Robert's uterus, a rare congenital abnormality of Mullerian duct development, consists of an oblique septum and non-communicating asymmetrical uterine hemi-cavity. The main symptoms are the presence of hematometra and severe dysmenorrhea. Septal resection is the main surgical procedure; however, the rarity and difficulty obtaining a pre-operative diagnosis lead to a high rate of misdiagnosis and second surgery.
Collapse
|