Robert's uterus with ipsilateral renal agenesis presenting as pelvic inflammatory disease in a teenager: A case report

Robert’s uterus, with ipsilateral renal agenesis, is an exceptionally rare Mullerian duct anomaly (MDA). It usually presents with cyclical pain, but presentation as pelvic inflammatory disease in an adolescent is extremely uncommon. We report a rare case of Robert’s uterus with ipsilateral renal agenesis in a 13-year-old girl, eight months post-menarche, who presented with 15 days of abdominal pain, copious purulent vaginal discharge, and fever. Ultrasonography suggested a septate/bicornuate uterus with a large, irregular pelvic collection. MRI demonstrated an asymmetric uterine septum forming a non-communicating left hemi-cavity and left renal agenesis. As an emergency procedure under anesthesia, 100 ml of hematinic purulent material was drained from the pouch of Douglas. After clinical stabilization for one week, hystero-laparoscopy was performed. Hysteroscopy revealed a normal vagina, single cervix, and right hemi uterus with right tubal ostia, whereas laparoscopy revealed a broad fundus, a dilated left tube and flimsy adhesions, findings suggestive of Robert’s uterus. Laparoscopic-guided hysteroscopic unification metroplasty was successfully done by incising the asymmetric septum using a bipolar Collins knife. A no. 8 Foley catheter was left in situ for one week to prevent adhesions. She recovered uneventfully and, at 9-month follow-up, experiences regular moderate menstrual cycles without dysmenorrhea or pain. Robert’s uterus is a rare Mullerian malformation that should be considered in the differential diagnosis of females presenting with features of pelvic inflammatory disease. Ipsilateral renal agenesis should be evaluated in patients diagnosed with Robert’s uterus.