case_images: PMC11327016_01
case_images: Preoperative imaging examination. (A) The red arrow points to the asymmetrical uterine septum, while the white arrow points to the obstruction site, i.e., the transverse uterine septum. However, the ultrasound was not completely clear, and the transverse uterine septum was not visualized. (B) The uterine fundus, indicated by the arrow, is depressed downward toward the uterine septum. Given that the thickness of the transverse uterine septum was below the MRI slice gap, the MRI image did not capture the transverse uterine septum.
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case_images: fig1
case_images: Review transrectal three-dimensional ultrasound (3D US) (GE Voluson E8, America) (Figure 1A) depicted that the horizontal transverse section of the uterine fundus revealed a hypoechoic separation between the two endometria, with a distance of roughly 3.3 cm between the bilateral uterine horns. MRI (Figure 1B) images delineated that the size of the uterus was about 4.7 x 3.7 x 7.0 cm, with a uterine body-to-cervical diameter ratio of about 3/4.
case_images: Cervical image during hysteroscopy. (A) The internal opening of the cervix is closed. (B) Brown menstrual blood outflow after puncturing the transverse uterine septum.
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case_images: fig2
case_images: The length of the cervical canal was 4 cm, and a transverse septum was identified 7 mm above the internal opening of the cervix, preventing access to the uterine cavity Figure 2A. The septum was punctured using an transabdominal US-guided (Mindray M11T, China) probing needle, unveiling the presence of brown menstrual blood, as illustrated in Figure 2B.
case_images: Intrauterine image. (A) The white arrow points to the right intrauterine adhesion, whereas the red arrow points to the oblique uterine septum. (B) The right fallopian tube opening could be visualized after the separation of the right uterine adhesion. (C) The left fallopian tube opening was exposed following the excision of the oblique uterine. (D) After complete resection of the oblique septum, the uterine cavity morphology was restored to normal.
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case_images: fig3
case_images: An oblique adhesive band was observed extending from the right side wall of the uterine cavity to the septum, and the opening of the right fallopian tube was visible, as displayed in Figures 3A,B. No menstrual blood retention was found inside, and the opening of the left fallopian tube was visible (Figure 3C). Most of the endometrium was defective, with only a small amount of endometrial tissue noted at the bilateral uterine horns (Figure 3D).
case_images: Two-dimensional model of Robert's uterus combined with transverse uterine septum.
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case_images: fig4
case_images: The two-dimensional model of the uterine cavity is portrayed in Figure 4.
case_images: Images during laparoscopy. (A) The white arrow points toward the adhesion in the left attachment area, while the red arrow points toward the adhesion in the right attachment area. (B) Displays the blind end of the right fallopian tube. (C) Exhibits the external uterine silhouette prior to hysteroscopic metroplasty, with a slight downward depression near the base of the left uterus. (D) The external outline of the uterus after hysteroscopic metroplasty reveals a fullness at the base of the uterus, indicating that uterine morphology was restored.
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case_images: fig5
case_images: Besides, the left fallopian tube and left ovary were wrapped and adherent to form a mass of about 4*3 cm (Figure 5A). At the same time, the right ovary was cystically enlarged by approximately 5*5*4 cm, exhibiting a multilocular morphology and filled with clear fluid (Figure 5A). A blind end of approximately 3.5 cm long was noted in the right fallopian tube, and no umbrella structure was observed (Figure 5B). The uterus was flat in the posterior position and measured about 4*3*3 cm (Figure 5C). The external outline of the uterus after hysteroscopic metroplasty reveals a fullness at the base of the uterus, indicating that uterine morphology was restored (Figure 5D).
case_images: Postoperative follow-up ultrasound and hysteroscopy. (A) There was no significant echo in the uterine cavity by postoperative 3D ultrasound. (B) Follow-up hysteroscopy after menstruation showed normal uterine cavity morphology, with a thin endometrial layer visible.
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case_images: fig6
case_images: On the 5th day after surgery, the intrauterine balloon was removed, and a 3D US showed no obvious abnormalities in the shape of the uterine cavity (Figure 6A). Hysteroscopy conducted on the 10th day of menstruation depicted normal uterine morphology, with a thin endometrial layer in the uterine cavity, partial endometrium defects, and visible openings of the bilateral fallopian tubes (Figure 6B).