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The Recto-Vesical Ligament: Myth or Reality?

DOI: 10.4236/oalib.1104911    159 Downloads   309 Views  

ABSTRACT

The recto-vesical ligament is an abnormal peritoneal band that can be associated with uterine malformations by default fusion of Müller’s ducts. It is a very rare entity. We report a case of laparoscopic surgery conducted on a 28-year-old patient in order to explore primary subfertility. We discover that the patient had two permeable vaginas, two distinct cervices and two com-pletely separate hemiuterus with two horns between which a wide peritoneal band attached to the bladder and back to the sigmoid: the ligament rec-to-vesical.

1. Case Report

A 28-year-old had consulted for wish of pregnancy. It was a history of primary subfertility whose etiological record had concluded tubal origin. A laparoscopy of tubo-peritoneal evaluation was performed, and allowed the discovery of a double uterus: bicornuate bicollis uterus with permeable vagina. The patient had two permeable vaginas, two distinct cervices and two completely separate hemiuterus with two horns between which a wide peritoneal band attached to the bladder and back to the sigmoid as shown in Figure 1: the ligament recto-vesical (Figure 2).

Furthermore, the exploration of the pelvic cavity showed the presence of peritoneal endometriosis superficial stains as shown in Figure 3.

2. Discussion

The recto-vesical ligament is an abnormal peritoneal band that can be associated

Figure 1. Laparoscopic view of the pelvis.

Figure 2. The recto-vesical ligament.

Figure 3. Signs of superficial peritoneal endometriosis.

with uterine malformations by default fusion of Müller’s ducts. It is a fold of connective tissue extending from the rectum to the bladder, crossing the junction between the two horns of the uterus [1] . It is a very rare entity [2] [3] that associates with the didelphys uterus and that extends between the bladder forward and the anterior face of the recto-sigmoid back, thus separating the two hemi-matrices of the bicornuate uterus [2] . This anatomical variant is associated with the bicornuate bicollis uterus class III according to the American Fertility Society/American Society for Reproductive Medicine (AFS/ASRM) classification [4] . In this case, the uterus may be a bicornuate bicollis permeable or with obstructed hemivagina [5] . Concomitant renal abnormalities are possible [3] [5] .

3. Conclusion

The recto-vesical ligament is not only a consequence of the failure of the Müller’s duct fusion, but its relation to the uterine malformation with or without vaginal and/or renal abnormality indicates a certain part of this structure in the early development of the urogenital system [3] .

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Briki, R. , Cherif, O. , Derouich, M. , Chachia, S. , Boughizane, S. and Khairi, H. (2018) The Recto-Vesical Ligament: Myth or Reality?. Open Access Library Journal, 5, 1-5. doi: 10.4236/oalib.1104911.

References

[1] Tow, S.H. (1960) The Double Uterus. A Review of Twenty-One Cases. Singapore Medical Journal, 1, 167-171.
[2] Jayi, S. and Abdelilah Melhouf, M. (2013) Inter-Vesico-Rectal Ligament Separating the Half-Matrices of a Unicervical Uterus Bicornis—About A Rare Case. Pan African Medical Journal, 15, 27.
https://doi.org/10.11604/pamj.2013.15.27.2773
[3] Heinonen, P.K. (2013) Rectovesical Ligament and Fusion Defect of the Uterus with or without Obstructed Hemivagina and Ipsilateral Renal Agenesis. European Journal of obstetrics, Gynecology, and Reproductive Biology, 168, 83-86.
https://doi.org/10.1016/j.ejogrb.2012.12.034
[4] The American Fertility Society (1988) The American Fertility Society Clas-sifications of Adnexal Adhesions, Distal Tubal Occlusions, Tubal Occlusion Secondary to Tubal Ligation, Tubal Pregnancies, Mul-lerian Anomalies and Intrauterine Adhesions. Fertility and Sterility, 49, 944-955.
https://doi.org/10.1016/S0015-0282(16)59942-7
[5] Fedele, L., Motta, F., Frontino, G., Restelli, E. and Bianchi, S. (2013) Double Uterus with Obstructed Hemivagina and Ipsilateral Renal Agenesis: Pelvic Anatomic Variants in 87 Cases. Human Repro-duction, 28, 1580-1583.
https://doi.org/10.1093/humrep/det081

  
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