Successful Uterine Preservation in Robert’s Uterus Masquerading As Non Communicating Rudimentary Horn

Study Objective

To highlight the challenge in diagnosis and management of a rare mullerian anomaly-Robert's uterus.

Design

A case report of successful management of Robert's uterus which was misdiagnosed as non communicating rudimentary horn.

Setting

A rare case managed on a tertiary care centre. Patient underwent in low lithotomy position for hysterscopy and laparoscopy.

Patients or Participants

The informed written consent was taken from the patient. She was a 17 year old unmarried female who presented with progressive dysmenorrhea. She was initially misdiagnosed as bicornuate uterus and genital tuberculosis as cause of hydrosalpinx on magnetic resonance imaging(MRI).

Interventions

On presentation to our institute, MRI was reviewed and the diagnosis of unicornuate uterus with adjacent functional rudimentary horn was made and patient was planned for hemihysterectomy. On further evaluation and 3D ultrasound, later there was diagnostic dilemma of Robert's uterus due to no external indentation of uterine fundus. She was planned for hystero-laparoscopy and proceed.

Measurements and Primary Results

Hysteroscopy revealed single ostia on right side. Laparoscopy showed a single broad uterine fundus, making a diagnosis of Robert's uterus with asymmetrical septa. Hysteroscopic septal resection was done using resectoscope under ultrasound guidance.

Conclusion

A high index of suspicion is required for rare mullerian anomalies in all adolescent girls presenting with progressive dysmenorrhea. Broad uterine fundus with no/slight external indentation and asymmetrical cavities should clinch a diagnosis of Robert uterus. Correct diagnosis avoids inappropriate surgery of hemihysterectomy and leads to restoration of normal uterine cavity.