Inappropriate surgery in a patient with misdiagnosed Robert's uterus

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.

Keywords: Dysmenorrhea; Hematometra; Mullerian anomaly; Robert’s uterus; Rudimentary horn; Septate uterus; Unicornuate uterus.

Fig. 1

Pre-operative findings. MRI scan in axial (a) and coronal (b) planes showing the right uterus and the left uterus with a 5 cm-sized hematometra (*) in the uterine cavity. An asymmetric uterine septum is found between the left and right uterine cavity, which are not communicating (yellow triangles). One cervix is confirmed and connected to the right uterus body (white triangles). The left and right uterine fundus are clearly not divided with a normal uterine fundal contour (white arrow). Hysteroscopy in the right uterus revealed a simple small cavity, not communicating with the left uterus (c). Hysterosalpingography also showed no traffic to the left uterine cavity and the compressed shape of the right uterine hemi-cavity with fallopian tube patency (d). RU right uterus, LU left uterus, RUC right uterine cavity, FT fallopian tube

Fig. 2

Laparoscopic intraoperative findings. a Intra-abdominal findings show slightly enlarged uterine corpus on the left side with normal bilateral adnexa. The uterine fundus is slightly concave, but not divided into two horns. b Hysteroscopy is inserted into the right uterus whose intra-cavity is illuminated and observed from the intra-abdomen by laparoscopy to mark the incision line. Left uterine cavity is not illuminated after its obliteration by the asymmetric uterine septum. c An incision is made longitudinally along the border between the hemi-uterus with the left blind cavity and the right unicornuate uterus in order to resect the left uterus with hematometra. d Final laparoscopic vision after resection of the left uterus with hematometra, left salpingectomy, and uteroplasty. US Uterine strand, RU Rudimentary uterus

Fig. 3

The findings of a follow-up MRI scan 3 years after the surgery. A uterus with a thick muscular layer (white arrow) was observed via the axial (a) and coronal (b) planes, and presented with a normal uterine appearance