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Dong J, Wang JJ, Fei JY, Wu LF, Chen YY. Laparoscopy combined with hysteroscopy in the treatment of Robert's uterus accompanied by adenomyosis: A case report. World J Clin Cases 2024; 12:5769-5774. [PMID: 39247731 PMCID: PMC11263057 DOI: 10.12998/wjcc.v12.i25.5769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert's uterus and perform further surgery when necessary. CASE SUMMARY We report a 41-year-old mother of two children with Robert's uterus who was examined and treated by laparoscopy and hysteroscopy. Unlike the existing cases reported in the literature, this patient had a late onset of Robert's uterus symptoms. Due to right tubal ectopic pregnancy 3 years previously, the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain. She was examined and treated by laparoscopy and hysteroscopy, and is completely asymptomatic at 5-year follow-up. CONCLUSION The typical obstructive Mullerian abnormality requires further surgery. Combined laparoscopy and hysteroscopy is an effective, minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.
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Affiliation(s)
- Jie Dong
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Jia-Jian Wang
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Jing-Ying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Li-Fang Wu
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Ying-Ying Chen
- Department of Gynecology, Huzhou Maternity & Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
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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.
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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
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Dong L, Qin S, Che R, Pei J, Hua X. Successful pregnancy in the blind hemicavity of Robert's uterus: a rare case report and brief literature review. BMC Pregnancy Childbirth 2023; 23:211. [PMID: 36978042 PMCID: PMC10044360 DOI: 10.1186/s12884-023-05541-5] [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: 04/11/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert's uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert's uterus. CASE PRESENTATION A 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert's uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions. CONCLUSIONS Pregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.
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Affiliation(s)
- Lingling Dong
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Shi Qin
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Ronghua Che
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Jindan Pei
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China
| | - Xiaolin Hua
- Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Shanghai Tongji University School of Medicine, 2699 West Gaoke Road, Shanghai, 201204, China.
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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.
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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
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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.
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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
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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.
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Kisu I, Nakamura K, Shiraishi T, Iijima T, Iijima M, Matsuda K, Hirao N. Inappropriate surgery in a patient with misdiagnosed Robert's uterus. BMC WOMENS HEALTH 2021; 21:264. [PMID: 34217289 PMCID: PMC8254971 DOI: 10.1186/s12905-021-01404-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Robert's uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert's uterus, resulting in an invasive and disadvantageous surgery. CASE PRESENTATION A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert's uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient's symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient's uterus susceptible to uterine rupture in any future pregnancy. CONCLUSIONS Although the early diagnosis of Robert's uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan. .,Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan.
| | - Kanako Nakamura
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Tetsuro Shiraishi
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Tomoko Iijima
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Moito Iijima
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Kiyoko Matsuda
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
| | - Nobumaru Hirao
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, 1908531, Japan
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Xiao F, Gao S, Tang X, Chen Y, Fang F. Oblique Cervical Septum with Complete Uterine Septum: Diagnosis and Treatment of a Rare Case. J Pediatr Adolesc Gynecol 2021; 34:84-87. [PMID: 32473321 DOI: 10.1016/j.jpag.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Müllerian anomalies take many forms of manifestation. The oblique cervical septum with a complete uterine septum (OCSCUS), as a rare form of Müllerian anomaly, has never been reported in the literature. CASE A 10-year-old female adolescent presented with progressive abdominal pain after the onset of menarche was diagnosed as OCSCUS using magnetic resonance imaging and treated with hysteroscopic dissection of the uterine part of the septum. SUMMARY AND CONCLUSION Greater awareness of the OCSCUS will lead to earlier detection and is the key to alleviating patient suffering and avoiding potentially severe complications, such as endometriosis and infertility. For the treatment of OCSCUS, hysteroscopic dissection of the uterine part of the septum is a minimally invasive treatment choice with low surgical risk.
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Affiliation(s)
- Fengyi Xiao
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Shujun Gao
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xindi Tang
- Shaoxing Shangyu Maternal and Child Health Hospital, Shaoxing, China
| | - Yisong Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Fang Fang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Yang QM, Li H, He SH, Chen D, Chen L. Pregnancy in a blind hemi-cavity of Robert's uterus with ipsilateral renal agenesis: a case report and literature review. J Int Med Res 2019; 47:3427-3434. [PMID: 31130027 PMCID: PMC6683884 DOI: 10.1177/0300060519850422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Robert’s uterus is an asymmetric septate uterus with a noncommunicating cavity and is a rare Müllerian anomaly. We present a rare case of pregnancy in a blind cavity and the first report of ipsilateral renal agenesis. A 23-year-old primigravida woman presented to our hospital at 7 weeks and 3 days of gestation after an abortion had failed. Three-dimensional ultrasound and magnetic resonance imaging showed pregnancy in a blind hemi-cavity of Robert’s uterus with an ipsilateral renal anomaly. Surgery was performed by hysteroscopy with laparoscopic and ultrasound guidance. The pregnancy was removed and the asymmetric septum was resected. A single normal uterine cavity with bilateral tubal ostium remained. The treatment was considered to be satisfactory. Menstruation ceased to be painful and the uterus was not scarred. Robert’s uterus can be well evaluated by an experienced ultrasound physician and magnetic resonance imaging. Such patients may have renal agenesis and the urinary system must be simultaneously evaluated. Pregnancy in a blind hemi-cavity is extremely rare and easily ignored by gynecologists and sonographers. Timely and accurate diagnosis of this condition is essential to obtain minimally invasive treatment.
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Affiliation(s)
- Qiao-Mei Yang
- 1 Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, China
| | - Hua Li
- 1 Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, China
| | - Su-Hui He
- 2 Department of Ultrasonic, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, China
| | - Dan Chen
- 1 Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, China
| | - Li Chen
- 1 Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, China
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