Recto-Vesical ligamentを認めた単頸双角子宮に対し、安全に腹腔鏡下子宮全摘術を行った１例

抄録

　Because bicornuate uterus is relatively rare, most obstetricians and gynecologists have minimal experience with this condition. In some cases, the rectovesical (RV) ligament, which is attached anteriorly to the bladder, is detected passing over and between the hemi-uteri and continuing posteriorly to the serosa of the sigmoid or rectum. Here we report a case in which bicornuate uterus with the RV ligament was safely treated by total laparoscopic hysterectomy (TLH).

Case: A 49-year-old woman, gravida 1 para 1, with a complete bicornuate uterus, underwent TLH because of endometrial hyperplasia without atypia or adenomyosis. Enhanced abdominal computed tomography before the operation showed no congenital anomalies of the urinary system. Laparoscopy identified the RV ligament attached anteriorly to the bladder between the hemi-uteri and posteriorly to the serosa of the sigmoid. The peritoneum of the vesicouterine pouch of the hemi-uteri was cut, and saline was then injected into the bladder and the RV ligament was resected. TLH was concluded without injury to the bladder or rectum.

Conclusion: Previous studies reported frequent detection of the RV ligament in cases of bicornuate uterus without renal agenesis. Safe TLH is possible if the RV ligament is resected with care taken to protect the bladder and rectum.