Diagnosis and treatment of Robert's uterus combined with transverse uterine septum: a case report and review of the literature

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.

Keywords: Robert’s uterus; asymmetric septate uterus; hysteroscopic metroplasty; transverse uterine septum; uterine malformation.

Figure 1

Preoperative imaging examination. (A) The red arrow points to the asymmetrical uterine septum, while the white arrow points to the obstruction site, i.e., the transverse uterine septum. However, the ultrasound was not completely clear, and the transverse uterine septum was not visualized. (B) The uterine fundus, indicated by the arrow, is depressed downward toward the uterine septum. Given that the thickness of the transverse uterine septum was below the MRI slice gap, the MRI image did not capture the transverse uterine septum.

Figure 2

Cervical image during hysteroscopy. (A) The internal opening of the cervix is closed. (B) Brown menstrual blood outflow after puncturing the transverse uterine septum.

Figure 3

Intrauterine image. (A) The white arrow points to the right intrauterine adhesion, whereas the red arrow points to the oblique uterine septum. (B) The right fallopian tube opening could be visualized after the separation of the right uterine adhesion. (C) The left fallopian tube opening was exposed following the excision of the oblique uterine. (D) After complete resection of the oblique septum, the uterine cavity morphology was restored to normal.

Figure 4

Two-dimensional model of Robert’s uterus combined with transverse uterine septum.

Figure 5

Images during laparoscopy. (A) The white arrow points toward the adhesion in the left attachment area, while the red arrow points toward the adhesion in the right attachment area. (B) Displays the blind end of the right fallopian tube. (C) Exhibits the external uterine silhouette prior to hysteroscopic metroplasty, with a slight downward depression near the base of the left uterus. (D) The external outline of the uterus after hysteroscopic metroplasty reveals a fullness at the base of the uterus, indicating that uterine morphology was restored.

Figure 6

Postoperative follow-up ultrasound and hysteroscopy. (A) There was no significant echo in the uterine cavity by postoperative 3D ultrasound. (B) Follow-up hysteroscopy after menstruation showed normal uterine cavity morphology, with a thin endometrial layer visible.