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Nishiuchi K, Uotani K, Kobayashi D, Ono Y, Yamasaki Y, Kashima Y, Nishijima M, Ueno Y, Imaoka I, Murakami T. Uterine diverticulum mimicking endometriotic cyst of the ovary. Radiol Case Rep 2024; 19:934-938. [PMID: 38188951 PMCID: PMC10767267 DOI: 10.1016/j.radcr.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/07/2023] [Indexed: 01/09/2024] Open
Abstract
Uterine diverticulum is a rare congenital malformation caused by abnormal fusion of the Müllerian ducts. The diagnosis of uterine diverticulum is difficult, and it is often misdiagnosed as a Müllerian duct anomaly, degenerated uterine fibroid, or ovarian cyst. We herein report a case of uterine diverticulum mimicking an ovarian endometriotic cyst. A multiparous woman with a history of normal vaginal delivery underwent magnetic resonance imaging for investigation of lower abdominal pain and fever. A 155-mm cystic lesion was observed on the ventral side of the uterus. The content of the cyst showed high signal intensity on T1- and T2-weighted images with precipitates of low signal intensity on the dorsal side, suggesting an endometriotic cyst of the ovary. Surgical and pathological findings revealed that the cyst was pedunculated from the anterior uterine body and composed of 3 layers: CD10-positive endometrium, a smooth muscle layer, and serosa. A uterine diverticulum was definitively diagnosed.
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Affiliation(s)
- Kentaro Nishiuchi
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kensuke Uotani
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Daigo Kobayashi
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Yumi Ono
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Yuko Yamasaki
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Yukio Kashima
- Department of Pathology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Mitsuhiro Nishijima
- Department of Obstetrics and Gynecology, Hyogo Prefectural Awaji Medical Center, Sumoto, Hyogo, Japan
| | - Yoshiko Ueno
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Izumi Imaoka
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takamichi Murakami
- Department of Diagnostic and Interventional Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Sako Y, Hirata T. Hysteroscopic management of uterine diverticulum after myomectomy: a case report. BMC Womens Health 2023; 23:452. [PMID: 37641054 PMCID: PMC10464432 DOI: 10.1186/s12905-023-02606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare. CASE PRESENTATION A 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved. DISCUSSION AND CONCLUSIONS This report highlights the similarities of the patient's diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy.
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Affiliation(s)
- Yusuke Sako
- Department of Obstetrics and Gynecology, St Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, St Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan.
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Kawatake R, Maebayashi A, Nishimaki H, Nagaishi M, Kawana K. Successful surgical treatment of postmyomectomy uterine diverticulum: a case report. BMC Womens Health 2023; 23:406. [PMID: 37537601 PMCID: PMC10398967 DOI: 10.1186/s12905-023-02539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Uterine diverticulum is classified into congenital and acquired types. The acquired type is caused by caesarean scar syndrome, which occurs after caesarean section. There are no detailed reports on diverticulum after enucleation of uterine fibroids. Most cases are treated with hysteroscopy or laparoscopy, but a management consensus is lacking. We treated a patient with a uterine diverticulum that had formed after uterine fibroid enucleation by combining hysteroscopic and laparoscopic treatments. CASE PRESENTATION The patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine fibroid on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine fibroid enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a 5-mm-diameter fistula was observed in the posterior wall of the uterus, and a contrast-enhanced pocket, measuring approximately 3 cm, was located behind it. Uterine diverticulum following enucleation of a uterine fibroid was diagnosed, and surgery was thus deemed necessary. The portion entering the fistula on the internal cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and closed with sutures. Resuturing was not performed after dissection of the right round ligament due to tension. The postoperative course has been good to date, with no recurrence. CONCLUSION Uterine diverticula after myomectomy may be treated with a combined laparoscopic and hysteroscopic approach, similar to caesarean scar syndrome.
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Affiliation(s)
- Rina Kawatake
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Aki Maebayashi
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Haruna Nishimaki
- Department of Pathology and Microbiology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Masaji Nagaishi
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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Akashi E, Ishiguro T, Nonaka T, Kobayashi A, Takakuwa K, Enomoto T. Enlarged uterine fibroid forming uterine diverticulum during pregnancy: a case report. BMC Pregnancy Childbirth 2021; 21:34. [PMID: 33413155 PMCID: PMC7792331 DOI: 10.1186/s12884-020-03505-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although uterine fibroids are a common gynecologic neoplasm, uterine diverticulum accompanied by a uterine fibroid is unique. In addition, pregnancy complicated with uterine diverticulum is extremely rare. We experienced a case of a uterine fibroid that was associated with a uterine diverticulum that enlarged during pregnancy and puerperium. CASE PRESENTATION A 25-year-old nulligravida woman had an abnormal uterine cavity surrounded by myomatous mass. After natural conception, the mass and pouch had enlarged during pregnancy. Six months after elective cesarean delivery, she underwent laparotomy because of abdominal pain caused by the myomatous mass and the fluid inside. The tumor was connected to the midline of the posterior wall of the normal uterus. The resected tumor was pathologically diagnosed as leiomyoma and diverticulum. CONCLUSIONS Pregnancy can stimulate uterine fibroids to form uterine diverticula. Resection of the diverticulum and fibroid is a useful option for symptomatic patients with desired future fertility.
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Affiliation(s)
- Erina Akashi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Tatsuya Ishiguro
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Taro Nonaka
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Akiko Kobayashi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Koichi Takakuwa
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-757, Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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DeStephano CC, Jernigan AM, Szymanski LM. Iatrogenic Uterine Diverticulum in Pregnancy After Robotic-assisted Myomectomy. J Minim Invasive Gynecol 2015; 22:902-5. [PMID: 25827328 DOI: 10.1016/j.jmig.2015.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/14/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
Uterine diverticula are rare outpouchings of the uterus associated with abnormal uterine bleeding, pelvic pain, dysmenorrhea, and adverse obstetric events. At the time of cesarean delivery at 36 5/7 weeks' gestation during the patient's first pregnancy and 36 6/7 weeks during the second pregnancy, a fundal iatrogenic uterine diverticulum at the site of a prior robotic-assisted myomectomy was noted. The outpouching communicated with the endometrial cavity and was extremely attenuated, palpably 2 to 3 mm thick. Further research is needed to determine the incidence of iatrogenic uterine diverticulum after robotic myomectomy and whether these malformations increase the risk of adverse obstetric outcomes.
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Affiliation(s)
- Christopher C DeStephano
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Amelia M Jernigan
- Division of Gynecology Oncology, Department of OB/GYN, Cleveland Clinic, Cleveland, Ohio
| | - Linda M Szymanski
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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