Objective

To present a case of didelphys uterus with severe pelvic pain and primary infertility with focal adenomyosis of outer myometrium (FOAM) of the left hemiuterus and tips and tricks for hemihysterectomy as a fertility preserving surgery.

Design

Descriptive step-by-step video demonstration of a case of didelphys uterus with adenomyosis of the hemiuterus. Local institutional review board approval for publication was obtained.

Setting

Endometriosis Centre, Apollo Hospitals, Hyderabad, India.

Patient(s)

Women with uterus didelphys with FOAM of the left hemiuterus with severe pelvic pain and infertility.

Intervention(s)

A 30-year-old woman presented with chronic pelvic pain and severe progressive dysmenorrhea with primary infertility for 3 years. She was diagnosed with uterus didelphys and longitudinal vaginal septum 3 years back and underwent hysteroscopy for septal resection and diagnostic laparoscopy for pain in an outside setting; however, no laparoscopic intervention was performed. The patient was diagnosed with FOAM of the left hemiuterus involving 75% of the hemiuterus. After detailed discussion and counseling regarding different options, laparoscopic hemihysterectomy was performed as pelvic pain relief was a major expected outcome along with fertility preservation.

Main Outcome Measure(s)

Pain relief with improved quality of life and fertility preservation.

Result(s)

The postoperative period was uneventful. The patient was discharged on the second postoperative day with no complaints. Her chronic pelvic pain and dysmenorrhea resolved. She was not prescribed any medication after the surgery. During the routine follow-up, she had a regular menstrual cycle with a visual analogue score of 0/10.

Conclusion(s)

The safe removal of a hemiuterus in case of a didelphys uterus with pathology of hemiuterus through a minimally invasive technique is possible, which cures the pain caused by adenomyosis and enables quick recovery while preserving future fertility.

中文翻译：

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双子宫一例：攻克子宫腺肌病与不孕症的双重烦恼

客观的

介绍伴有严重盆腔疼痛和原发性不孕伴左侧半子宫局灶性外肌层腺肌病 (FOAM) 的双子宫双子宫切除术作为保留生育力手术的提示和技巧。

设计

双子宫双子宫腺肌病病例的描述性分步视频演示。获得了当地机构审查委员会的出版批准。

环境

印度海得拉巴阿波罗医院子宫内膜异位症中心。

病人）

双子宫双子宫伴左侧半子宫 FOAM 的女性伴有严重的盆腔疼痛和不孕。

干预措施

一名 30 岁的女性因慢性盆腔疼痛和严重进行性痛经伴原发性不孕 3 年就诊。她在 3 年前被诊断出患有双子宫和阴道纵隔，并接受了宫腔镜手术以进行隔膜切除术和诊断性腹腔镜检查以解决外部环境中的疼痛；然而，没有进行腹腔镜手术。患者被诊断为左侧半子宫 FOAM，累及 75% 的半子宫。在对不同的选择进行详细讨论和咨询后，进行了腹腔镜半子宫切除术，因为盆腔疼痛缓解是一个主要的预期结果，同时保留了生育能力。

主要观察指标）

通过改善生活质量和保留生育能力来缓解疼痛。

结果）

术后期间平安无事。患者在术后第二天出院，没有任何不适。她的慢性盆腔疼痛和痛经得到了解决。手术后没有给她开任何药物。在常规随访期间，她的月经周期规律，视觉模拟评分为 0/10。

结论

对于伴有半子宫病理的双子宫，可以通过微创技术安全切除半子宫，治愈子宫腺肌病带来的疼痛，实现快速恢复，同时保留未来的生育能力。