Rare Anatomical Variant of Septate Uterus - A Case Report

Congenital uterine anomalies are defined as changes of normal uterine anatomy, determining the clinical manifestations and reproductive prognosis of these patients. Uterine malformations are the result embryonic development deficiencies of paramezonephrotic ducts. Classification systems ESHRE/CONUTA and AFS use as basis parameters the uterine anatomy and embryology. Case report. A 31 years old nulligesta patient presented for infertility diagnosis. The patient had no previous gynaecological examination. Clinical examination revealed the presence of two vagina and double cervix. Transvaginal ultrasound suggests the presence of two endometrial cavities and two cervixes, prompting for hysteroscopy and laparoscopy. Hysteroscopy reveals two vaginas, double cervix, two endometrial cavities, each with a permeable tubal ostium. Right tubal ostium was normally implanted in the cornus of the right hemiuterus, while the left tubal ostium straight at the left hemiuterus fundus. Laparoscopy was performed, revealing a particular outline of the uterus, with normal implantation of both tubes and indentation in the midline of the uterus, less than 50% of myometrium thickness. The anomaly was classified U2b, C2, V2 in ESHRE/CONUTA classification, although U2 class has a normal outline. Our opinion is that the diagnosis necessitated all the investigations performed; none of these could establish alone the diagnosis. Discussions. Clinical examination is the first step of gynecological examination, revealing anomalies of vagina and cervix. Ultrasound is the first imagistic investigation, that raise the suspicion of two endomerial cavities. For definitive diagnosis and ESHRE classifying, hysteroscopy and laparoscopy are mandatory.