Pregnancy in a blind hemi-cavity of Robert’s uterus with ipsilateral renal agenesis: a case report and literature review

Robert’s uterus is an asymmetric septate uterus characterized by a uterine septum dividing the uterine cavity into a blind hemi-cavity and a contralateral nonobstructing hemi-cavity that is connected normally to the cervix. The blind cavity obstructs menstrual flow and permits partial reflux of retained menstruation into the peritoneal cavity,1 resulting in hematometra, dysmenorrhea, hematosalpinx, and even endometriosis. Endometriosis includes ovarian and deep infiltrating endometriosis, which is accurately detected by transvaginal ultrasound, but superficial endometriosis needs to be detected by laparoscopy.2 There are three main clinical types of Robert’s uterus as follows: (i) with a large hematometra, (ii) without hematometra, and (iii) with a small hematometra in a blind hemi-cavity.3 Another type of Robert’s uterus with a small hematometra or without hematometra can occur, as in our case, before pregnancy. To date, only a few cases have been reported in the literature with pregnancy in the noncommunicating cavity.4 These were finally confirmed as pregnancy in one blind cavity of Robert’s uterus due to recurrent failed attempts at terminating the fetus in middle and late pregnancy. These cases underwent laparotomy and had a permanent scar in the uterus. We report a rare case of pregnancy in a blind cavity of Robert’s uterus. This is the first case of early pregnancy treated by hysteroscopy with laparoscopic and transabdominal ultrasound guidance. We discuss the importance of early and accurate diagnosis for guiding appropriate surgery. Our case is also unique because of its atypical presentation as ipsilateral renal agenesis.