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Minimally invasive treatment of asymetric uterine septum (roberts uterus)

A 26-year-old lady presented with heavy bleeding along with dysmenorrhoea during periods for the last five years. She has been married for the last four years and presented with primary infertility. In the past, she gives the history of appendicectomy at the age of 18 years. She underwent Dilatation & Curettage, 2 months back which was reported as an endometrial polyp. She is a known case of hypothyroidism on replacement therapy. On presentation, her last menstrual period was 10 days ago.

The general examination did not reveal any abnormality. The pelvic examination showed normal cervix with eight weeks size uterus and tenderness in the left fornix. Ultrasound examination reported as broad fundus with two horns. There was evidence of adenomyosis in the right horn. The left horn of the uterus showed hematometra that was not communicating with the right side of the uterus and cervix (Figure 1). Further evaluation with MRI showed similar findings (Figure 2). A diagnosis of Roberts uterus with Asymmetrical septum of the uterus was made.

She underwent a diagnostic laparoscopy which confirmed the diagnosis. It additionally had evidence of vesicular early endometriosis on the surface of the uterus and edematous left tube adherent to the left ovary (Figure 3). On hysteroscopy, the right Ostia was seen in the uterine cavity. The left Ostia was absent. Complete septum dividing the two cavities seen (Figure 4). The uterine septum was identified and resected using the Collins knife. The left cavity was identified by dark brown old blood draining (Figure 5). Once the septum was resected the left uterine cavity could be reached and the left Ostia identified (Figure 6).

This was a rare case of Mullerian abnormality and a variant of septate uterus. This case was managed by minimal access surgery, of a combination laparoscopy and Hysteroscopy. On follow up, the patient has a functioning full cavity uterus with no dysmenorrhoea and is expected to have a better reproductive outcome.

Dr Rooma Sinha, MD, DNB, MNAMS (Consultant Gynecologist, Laparoscopic & Robotic Surgeon)

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