A Rare Association of Bladder Endometriosis, Unicornuate Uterus, and Hematometra: A Case Report

Endometriosis involving the urinary tract is uncommon, with the urinary bladder being the most frequently affected site.Its nonspecific urinary manifestations may result in delayed diagnosis.Congenital Müllerian anomalies, particularly a unicornuate uterus with a noncommunicating functional rudimentary horn, may be associated with hematometra and endometriosis secondary to obstructed menstrual outflow and retrograde menstruation.We report an unusual coexistence of bladder endometriosis, a right unicornuate uterus with a noncommunicating left rudimentary cavity, and hematometra in a 22-year-old nulliparous woman who presented with a one-year history of cyclical dysuria, hematuria, and dyspareunia.She had regular menstrual cycles associated with dysmenorrhea and had attempted conception without success.Pelvic magnetic resonance imaging demonstrated a right hemi-uterus measuring approximately 7 × 3 × 2.5 cm and a separate left-sided endometrial cavity measuring 4.1 × 3.5 × 4.2 cm, which did not communicate with the uterus and was distended with hematometra.An ill-defined T2 hypointense lesion measuring 3.4 × 2.3 × 3 cm with T1 hyperintense foci was centered in the vesicouterine pouch, extending posteriorly into the lower uterine segment and cervix and anteriorly into the bladder wall with intraluminal extension.Thickening of the proximal bilateral round ligaments was also noted, with the overall appearance suggestive of deep pelvic endometriosis.Cystoscopy showed multiple reddish-brown cystic lesions involving the lateral and posterior walls of the urinary bladder.Near-complete transurethral resection of the bladder lesions was performed, along with laparoscopic drainage and partial excision of the rudimentary horn.Histopathological examination of the resected bladder lesions confirmed bladder endometriosis.Postoperatively, the patient was started on leuprolide acetate and remained symptom-free at six-month follow-up.This case highlights the importance of considering bladder endometriosis in young women presenting with cyclical urinary symptoms and demonstrates the value of magnetic resonance imaging in delineating Müllerian anomalies, hematometra, and the extent of deep pelvic endometriosis.The coexistence of extensive bladder endometriosis with a unicornuate uterus and hematometra underscores the importance of coordinated urological and gynecological management.