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
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Figure 1. Laparoscopic view of the pelvis.
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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] .