Hysteroscopic unification of a complete obstructing uterine septum: case report and review of the literature.
OBJECTIVE
To report a case of complete obstructing uterine septum repaired in a minimally invasive manner by operative hysteroscopy under laparoscopic guidance. A complete obstructing uterine septum is a rare congenital abnormality. To date, management of such abnormalities has traditionally been by metroplasty.


METHODS
Case report and review of the literature.


METHODS
Pediatric and adolescent gynecology service at a tertiary care hospital.


METHODS
A 16-year-old nulligravid presented with severe, persistent dysmenorrhea and a history of significant endometriosis. Imaging initially suggested a functional, noncommunicating uterine horn, but magnetic resonance imaging review confirmed a complete obstructing septate uterus.


METHODS
The patient was managed by menstrual suppression until the time of surgery. The septum was resected by operative hysteroscopy under laparoscopic guidance. The procedure was without complication.


METHODS
The patient recovered well and resumed spontaneous menses without dysmenorrhea.


RESULTS
A second-look hysteroscopy 4 months later confirmed patency of the previously obstructed side and allowed the opportunity to complete the resection of the septum.


CONCLUSIONS
Operative hysteroscopy is an effective and safe minimally invasive technique to manage the rare complete obstructing uterine septum. Hysteroscopy is less invasive than traditional metroplasty and is associated with easier recovery. Additionally, there is no uterine scar and thus less implication for future fertility. Further series of such procedures are required to offer greater experience and proof of safety of this approach.
Spitzer
Rachel F
RF
Department of Pediatrics, Division of Endocrinology, Section of Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Caccia
Nicolette
N
Kives
Sari
S
Allen
Lisa M
LM
D000293:Adolescent; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D024162:Second-Look Surgery; D016896:Treatment Outcome; D014599:Uterus / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*