Laparoscopic subtotal hysterectomy in a case of uterine didelphys

Major congenital uterine anomalies present a management dilemma in women who are symptomatic and not responsive to medical therapy. This case report discusses the role of laparoscopic subtotal hysterectomy in a woman with uterine didelphys, who presented with a long-standing history of menorrhagia, which had not responded to medical treatment.

This case report represents the role of laparoscopic subtotal hysterectomy in a woman with uterine didelphys, who presented with a long-standing history of menorrhagia, which had not responded to medical treatment with tranexamic acid and mefenamic acid, or cyclical norethisterone. Transvaginal ultrasound examination, performed as part of the routine investigation into the cause of her symptoms, was suggestive of a congenital uterine anomaly. Uterine didelphys was the suspected classification, and at the time of hysteroscopic examination, a double cervix with two separate uterine corpora was noted. An intravenous uretero-pyelogram confirmed an anatomically normal urinary tract. In view of the diagnosis and severity of symptoms, neither the Mirena intrauterine system, nor endometrial ablative techniques were considered appropriate treatments. Surgical options, including hysterectomy by the abdominal and laparoscopic routes, were discussed. She was counselled as to the potential difficulty of laparoscopic surgery, but she elected to proceed to laparoscopic subtotal hysterectomy. The procedure was performed as a Day-case and went uneventfully.

Day-case laparoscopic subtotal hysterectomy may be considered as a potential treatment option in symptomatic women with major congenital uterine anomaly, in whom fertility potential is no longer an issue. Accurate pre-operative assessment of the upper urinary tract is considered essential.