Hysteroscopic Surgery for Intrauterine Scar Adhesions after Laparoscopic Metroplasty in a Patient with a Unicornuate Uterus and a Functional Noncommunicating Rudimentary Horn.

Technical video showing hysteroscopic surgery for intrauterine scar adhesions after laparoscopic metroplasty.

Under the guidance of B-ultrasound, the scar adhesions between the unicornuate uterus and rudimentary horn were carefully incised by scissors, then the incision was extended to achieve the best anatomical shape of the uterine cavity [ Figure 1 ]. A T-shaped intrauterine device was connected to the catheter scissored from a 14-F Foley catheter. This frame was inserted into the left rudimentary horn to avoid intrauterine adhesions and obstruction after the surgery. The process of hysteroscopic operation. (a) Hysteroscopy entered the unicornuate uterine cavity. (b) The scar adhesions between the unicornuate uterus and the rudimentary horn. (c) Incised the scar adhesions by scissors. (d) Hematometra was drained from the rudimentary horn. (e) Extended the incision. (f) Inserted the T-shaped intrauterine device into the left uterine cavity http://www.apagemit.com/page/video/show.aspx?num=331&kind=2&page=1

The objective of this study was to introduce a case that involves intrauterine obstruction due to scar adhesions after laparoscopic metroplasty in a patient with a unicornuate uterus and a functional, noncommunicating rudimentary horn.

An 18-year-old patient had laparoscopic metroplasty due to a unicornuate uterus with a functional noncommunicating rudimentary horn in our hospital. Nine months after the operation, she suffered from severe dysmenorrhea again. Pelvic magnetic resonance imaging showed that a septum was formed between the unicornuate uterus and rudimentary horn, and an obvious hematometra was in the rudimentary horn.

The operation was successful. The surgical procedure lasted less than an hour. At 6 months after surgery, the symptoms of dysmenorrhea were relieved. B-ultrasound did not find hematometra and the position of the T-shaped intrauterine device and catheter was normal.

Unicornuate uterus with a functional noncommunicating rudimentary horn is the most common type of Müllerian anomalies.[ 1 ] This disease is associated with obstructive symptoms of the rudimentary horn after menarche that leads to dysmenorrhea, endometriosis, and infertility.[ 1 ] Patients with this disease are likely to have renal anomalies due to the close relationship between the development of urinary and reproductive systems.[ 2 ] Amputation of obstructed horns is an effective choice to solve obstructive symptoms.[ 3 4 5 ] However, metroplasty can increase the uterine length and uterine cavity length, which is an acceptable alternative to resection for a noncommunicating rudimentary horn with a functional endometrium.[ 6 ] For patients with a unicornuate uterus and a functional noncommunicating rudimentary horn, it is necessary to place an intrauterine catheter when performing laparoscopic metroplasty to avoid anastomotic stoma scar adhesions. The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Xiaotong Liu collected the data and wrote the paper. Xuyin Zhang collected the data and wrote the paper. Keqin Hua designed the study and reviewed the manuscript. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Nil. There are no conflicts of interest.