A Complex Müllerian Anomaly Misdiagnosed as Fibroid Uterus: A Case Report

This is the authors' abstract. We don't add key points for this paper.

We report a 47-year-old woman who had never been pregnant and had suffered from primary infertility. She also had chronic pelvic pain and irregular menstrual periods. She had several uterine abnormalities, including a complete septate uterus, a duplicated cervix, and a longitudinal vaginal septum, with primary infertility. Her diagnosis included a large endometrial polyp and submucosal fibroids in the uterine cavity. This has been reported in only a few cases. The ultrasound diagnosis revealed a single uterine body with a single endometrial cavity and uterine fibroids but missed other diagnoses of two separate cervical canals, a double cervix, or separate vaginal canals, and a large endometrial polyp. The patient opted for definitive treatment and declined fertility preservation, leading to a total abdominal hysterectomy and removal of the uterine corpus, both cervices, and the vaginal septum. She was discharged five days after surgery and recovered. There are three clinical aspects to this case. First, imaging techniques (ultrasonography and MRI) should be used to diagnose and classify atypical Müllerian duct anomalies (MDAs) before applying a classification system. Second, in hysteroscopic septal resection, treatment should be individualized based on age, disease severity, and reproductive status. For younger women who wish to conceive, hysteroscopic septal resection is generally the most appropriate option, and hysterectomy is usually the last resort for suitable candidates. Finally, a multidisciplinary approach is necessary to deal with congenital anomalies that are complicated by acquired uterine pathologies. The diagnostic and surgical plan is required for such a patient to achieve optimal outcomes.