Uterus Didelphys dengan Agenesis Servik Bilateral

Dwinda Rizary, Dedy Hendry
In: Andalas Obstetrics And Gynecology Journal · 2020 · pp. 133–138 · doi:10.25077/aoj.4.1.133-138.2020 · W3111887423
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This case report details the management of a 34-year-old woman with uterus didelphys, bilateral cervical agenesis, and a non-fuctional hypoplastic uterus, ultimately undergoing hysterectomy for a separate adenomyotic mass.

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This case report describes a 34-year-old woman with primary amenorrhea and infertility who was diagnosed with uterus didelphys and bilateral cervical agenesis. Imaging and laparoscopy revealed two uterine masses, one of which contained adenomyosis and was located laterally in the pelvis, while the other was a hypoplastic, non-functional uterus. Due to the difficult location of the adenomyotic mass, which precluded successful uterovaginal anastomosis for fertility preservation, the surgical team performed a hysterectomy on that specific lesion. The final histopathology confirmed the presence of adenomyosis within the excised tissue. This paper is centrally about endometriosis and adenomyosis — specifically, it documents a rare concurrent presentation of adenomyosis within a rudimentary horn of a uterus didelphys anomaly.

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Abstract

LATAR BELAKANG : Anomali duktus mullerian adalah kelainan kongenital sistem reproduksi wanita yang disebabkan oleh perkembangan embriologis yang abnormal selama dalam kandungan. Jika disertai dengan agenesis serviks dan infertilitas maka harus dilakukan tindakan intervensi. Diagnosa yang akurat dan penanganan yang tepat sangat menetukan terhadap masa depan reproduksi dan penanganan infertilitas pada pasien.OBJEKTIF : Melaporkan penanganan kasus uterus didelphys yang disertai dengan agenesis serviks bilateral.METODE : Laporan kasusKASUS : Dilaporkan kasus wanita usia 34 tahun dengan amenore primer dan infertilitas primer 9 tahun, nyeri siklik yang tidak khas, perkembangan seks sekunder yang normal dan dari pemeriksaan ginekologi didapatkan agenesis servik. Pemeriksaan USG transvaginal didapatkan adanya massa dengan kesan adenomiosis. Dilakukan laparoskopi tampak 2 massa, 1 massa menyerupai adenomiosis dengan ukuran 9x6x5cm berlokasi di lateral pelvis kiri dan massa lain berupa uterus hipoplasia dengan ukuran 2x2x1cm tampak 2 tuba dengan 2 ovarium dalam batas normal. Massa uterus yang menyerupai adenomiosis dengan lokasi jauh dari vagina sehingga sulit dilakukan anastomoses sedangkan uterus lainnya hipoplasia dan non fungsional. Dilakukan histerektomi pada massa adenomiosis dengan hasil PA adenomiosis.KESIMPULAN : Uterus didelphys dengan agenesis serviks bilateral dengan 1 uterus adenomiosis dan terletak dilateral pelvis sulit dilakukan anastomose uterovagina sehingga dilakukan histerektomi. Uterus kedua hipoplasia dan nonfungsional sehingga tidak dilakukan tindakan apa-apa. Perlu dipikirkan “future fertility” pada pasien ini dan berbagai pilihan cara untuk memiliki anak.Kata kunci:Amenore Primer, Uterus Didelphys, Agenesis Serviks, Adenomiosis
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Background

The mullerian duct anomaly is a congenital abnormality of the female reproductive system caused by abnormal embryological development during pregnancy. If accompanied by cervical agenesis and infertility, intervention must be taken. Accurate diagnosis and proper treatment are very crucial to the future of reproduction and treatment of infertility in patients.

Objective

Reporting the handling of cases of uterine didelphys accompanied by bilateral cervical agenesis.

Method

Case report Case: Reported cases of women aged 34 years with primary amenorrhea and 9 years primary infertility, not typical cyclic pain, normal secondary sex development and from gynecological examination obtained cervical agenesis. Transvaginal ultrasound examination found a mass with the appearance of adenomyosis. Laparoscopic performed show 2 masses, 1 mass resembling adenomyosis with a size of 9x6x5cm located lateral to the left pelvis and another mass in the form of a hypoplastic uterus with a size of 2x2x1cm visible 2 tubes with 2 ovaries within normal limits. Uterine mass resembling adenomyosis with a location far from the vagina making it difficult to do anastomoses while other uterus hypoplasia and non-functional. Hysterectomies were performed on the mass of adenomyosis with the results of PA was adenomyosis.

Conclusion

The uterus didelphys with bilateral cervical agenesis with 1 uterine adenomyosis and located in the pelvic lateral it was difficult to do uterovaginal anastomose so that hysterectomy was performed. Second uterine was hypoplasia and non-functional so that no action was taken. Need to think about "future fertility" in these patients and various options for having children.

Keywords

Primary Amenorrhea, Uterine Didelphys, Cervical Agenesis, AdenomyosisReferences Parikh, R., et al. (2013). "Mullerian anomalies: a cause of primary amenorrhea." International Journal of Reproduction, Contraception, Obstetrics and Gynecology: 393-397. Boehnke, M., et al. (2016). "Uterine didelphys with concomitant renal anomalies in both mother and fetus." Journal of Pediatric Surgery Case Reports 14: 19-21. Acien, P., et al. (2009). "Mullerian anomalies "without a classification": from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina." Fertil Steril 91(6): 2369-2375. Helmy, Y. A. (2017). "Cervical agenesis with a functioning uterus: Successful surgical treatment by Foley’s catheter stent: A case report." Middle East Fertility Society Journal 22(1): 67-69. Fritz M, Sperrof L. Clinical Gynecologi endocrinoloy and Infertility 8 th edition. Lippicort WiliiamWillims. USA; 2011. Haydardedeoglu, B. and P. Caglar Aytac (2016). "A novel approach for congenital absence of the uterine cervix: Office hysteroscopic versapoint canalization using real-time trans-abdominal sonography guidance." Turk J Obstet Gynecol 13(1): 42-45. Yoshiki, N., et al. (2008). "Unusual uterus didelphys presenting in the retroperitoneum." Fertil Steril 90(2): 427-428. Lakshmy, S. and N. Rose (2016). "Congenital absence of uterine cervix." International Journal of Reproduction, Contraception, Obstetrics and Gynecology: 3634-3636. Adair, L., 2nd, et al. (2011). "Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: common presentation of an unusual variation." J Radiol Case Rep 5(1): 1-8. Arnold, K. C., et al. (2018). "Uterine Didelphys with Bilateral Cervical Agenesis in a 15-Year-Old Girl." J Pediatr Adolesc Gynecol 31(1): 64-66. Mahmud, Nusrat, et al.(2014). “Successful Uterovaginal Anastomosis in An Unusual Presentation of Congenital Absence of Cervix.†J. South Asian Federation Of Menopause : 105-110 Downloads Published How to Cite Issue Section License Copyright (c) 2020 JOURNAL OBGIN EMAS This work is licensed under a Creative Commons Attribution 4.0 International License.

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