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A Large Cervical Diverticulum Represented As Asherman's Syndrome Publisher



Tanha FD1 ; Dehbashi Z2 ; Harandi MA3
Authors
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Authors Affiliations
  1. 1. Department of Reproductive Endocrinology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Department of Obstetrics and Gynecology, Reproductive Endocrinology of Women Hospital, Tehran University of Medical Sciences, North Ostadnejatollahi Avenue, Villa Street, Tehran, 15978, Iran
  3. 3. Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

Source: Journal of Gynecologic Surgery Published:2019


Abstract

Background: Cervical diverticulum is a rare clinical malformation. The most-common clinical manifestation of such diverticula is menometrorrhagia, because a pouch develops for collecting menstrual blood. Case: A 37-year-old, gravida 1 para 1 woman was referred for menometrorrhagia and secondary infertility. Hysterosalpingography (HSG) showed irregularity in the uterine cavity without contrast agent spillage from the uterine tubes and indicated that she had Asherman's syndrome. She had a history of primary and secondary infertility, polycystic ovaries, three unsuccessful intrauterine inseminations (IU1s), and three unsuccessful intracycloplasmic sperm injections (ICSIs). All of these procedures had failed, and she finally conceived spontaneously. She was examined, via hysteroscopy and laparoscopy. A large diverticulum was noted between the internal and external os of her cervix that created obstacles to accessing the uterine cavity and led to the false report of Asherman's syndrome on the HSG. Results: Two days after the hysteroscopy and laparoscopy, transvaginal ultrasound evaluation of this patient showed the same findings as in the first ultrasound report. Therefore, the current authors assume that this space is a large diverticulum that is an obstacle to accessing the uterine cavity. Conclusions: In infertile patients who have HSGs indicating Asherman's syndrome and who complain of menometrorrhagia, cervical diverticulum could be the etiology. IUI and transfer of the embryo to the uterus guided by ultrasound is the recommended procedure for helping these patients achieve pregnancy. © 2019, Mary Ann Liebert, Inc., publishers.