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.

Challenges in the diagnosis and management of Robert's uterus: Systematic review and case presentation

“…18 More than half of women referred dysmenorrhea (54.3%), but in 14.3% of the cases the abdominal pain was diffused and intense 4,11,24 and 5,7% of the patients had nausea and vomiting. 13,16,22,26 14.3% of patients did have coexisting endometriosis at imaging. 12,15,18,21,24,27 The surgical interventions most commonly combine laparoscopic and hysteroscopic techniques, implemented in approximately 60% of the studies.…”

“…However, the patient's exceptionally young age and virginity created a unique but data‐limited context. The youngest patient previously described was 13 years old, 18 with a mean age of 23 years, and only two patients were virgins, 13,18 so this represents a limitation for the evaluation of the fertility outcomes in our case.…”

“…The youngest patient previously described was 13 years old, 18 with a mean age of 23 years, and only two patients were virgins. 13,18 All women had their menarche except for a 29-year-old woman with primary amenorrhea and chronic pelvic pain. 14 11.4% of women reported a history of miscarriage, 17,18,21 5.7% reported primary infertility 18 and only two women were multiparous.…”

“…An analysis of surgical techniques across the reviewed cases reveals a patchwork of approaches. Laparotomy was utilized in a mere 8.6% of cases, 4,23,24 exclusive HS was implemented in 20%, 10,11,16,20,26 laparoscopy alone accounted for 11.4%, 13,18,19 while SonoHysteroAVC was performed in only 3 cases. 17 Such variability prompts questions about the optimization of surgical procedures, particularly when it comes to mitigating symptoms and enhancing fertility.…”

Robert's Uterus Versus Juvenile Cystic Adenomyoma – Diagnostic and Therapeutic Challenges – Case Report and Review of Literature

“…Although unclear, the pathophysiology is considered to be ectopia or duplication and persistence of ductal Mullerian tissue in a critical area at the level of the attachment of the round ligament. [ 5 ] The criteria proposed for diagnosing JCA include age <30 years; cystic lesion >1 cm in diameter, independent of the uterine cavity and covered by hypertrophic myometrium, as seen on radiologic images and association with severe dysmenorrhoea. [ 4 6 ]…”