Laparoscopic Resection of Obstructed Hemi-uteri in a Series of Adolescents

Abstract

Background Obstructive congenital anomalies of the Mullerian tract can result in acute and/or chronic pain. These congenital anomalies most likely present during adolescence, and the diagnosis may be difficult to delineate if there is an obstructed hemi-uterus with an active endometrium and a patent non-obstructed hemi-uterus communicating with the single cervix and vagina. Cases Three young women (ages 15, 17, and 17 years) each presented with a complaint of a history of chronic pelvic pain since menarche, with increasing severity of acute and chronic pain. Pelvic ultrasound findings varied and included: a “normal” pelvis, a “complex adnexal mass”, and an “obstructed hemi-uterus with hematometra”. Each patient underwent an operative laparoscopy to evaluate the pelvic pain. In each case the examination revealed: a normal vagina, a single cervix communicating with a unicornuate uterus, and a non-communicating obstructed hemi-uterus. The cervix was cannulated and blue dye was instilled to confirm the communication of the cervix with the non-obstructed hemi-uterus. A total of 4 surgical ports were placed: one 10 mm umbilical port, and three 5 mm suprapubic ports. As demonstrated in the photographic images, cautery was used to transect the round ligament on the side of the obstructed hemi-uterus, the peritoneum over the bladder was dissected free from the hemi-uterus, and the utero-ovarian ligament was cauterized and transsected after having identified the ureter on the affected side. The fibrous band of tissue adjoining the obstructed and non-obstructed hemi-uteri was then identified, cauterized, and transsected. The hemi-uterus was then morcellated and removed through the 10 mm umbilical port site. The patients tolerated the outpatient surgical procedure well without complications. Pathologic evaluation confmned the obstructed uterine horns; all had evidence of pelvic peritoneal endometriosis, and 2 of the 3 had evidence of adenomvosis with in the obstructed hemi-uterus. Conclusions Obstructed hemi-uteri can be difficult to diagnose due to the co-existence of a patent and non-patent tract; once identified, an obstructed rudimentary uterine hom can safely be resected laparoscopically