The exact incidence of cervical cancer occurring in patients with Müllerian anomalies is unknown as both conditions are relatively rare and the literature is compromised principally of individual case reports or small series. Despite the rarity of this coexistence, the literature consistently highlights the significant diagnostic and therapeutic challenges it presents. This is particularly true when cervical duplication is present as the altered anatomy can hinder adequate cytologic sampling and delay the detection of malignant lesions. We report a case of unilateral invasive endocervical adenocarcinoma in a 43-year-old patient with complete septate uterus and longitudinal vaginal septum. The tumor was confined to the left cervix, staged as FIGO IB2 and underwent a type C1 radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy. Following the histologic confirmation of a well-differentiated adenocarcinoma with lymphovascular invasion and pelvic nodal metastasis the patient underwent chemoradiation and remains disease-free at five years. This case highlights how cervical duplication, particularly in the presence of a longitudinal vaginal septum may compromise routine screening and underscores the importance of careful anatomic assessment to ensure accurate diagnosis and individualized management in patients with uncommon Müllerian variants.

We describe the first written description of chronic pelvic pain secondary to venous congestion isolated to a longitudinal vaginal septum. A 29-year-old nulliparous female with chronic pelvic pain was diagnosed with a complete longitudinal vaginal septum and complete septate uterus. The patient desired surgical management, and the vaginal septum was excised without complications. Vascular congestion of the septal tissue was noted on pathology, and postoperatively, the patient's pelvic pain improved significantly. Typically, patients with a longitudinal vaginal septum present with pain isolated to vaginal penetration. For atypical presentations like chronic pelvic pain, surgical resection is reasonable to consider with shared patient decision-making.

Complex Müllerian anomalies, such as a complete septate uterus (U2b), cervical duplication (C2), and a non-obstructive longitudinal vaginal septum (V1), are rare malformations with intricate embryological origins. They often remain undiagnosed in the absence of specific clinical symptoms. This case highlights the diagnostic value of pelvic magnetic resonance imaging (MRI) and the therapeutic benefit of personalized surgical management. In our patient, surgical resection of the vaginal septum led to significant symptomatic improvement, including the restoration of a satisfactory sexual life.

Cervical insufficiency is a significant cause of second-trimester loss and preterm birth. Transabdominal cerclage is indicated after failed transvaginal cerclage or anatomical factors that make a vaginal approach technically difficult-such as müllerian anomalies, prior cervical surgery, or cervical duplication. In patients with müllerian anomalies undergoing a cerclage placement, it is critical to properly identify the anatomy for surgical planning and patient counseling of the cerclage method. To describe transabdominal cerclage indications and surgical technique and to illustrate a needleless laparoscopic abdominal cerclage placement in a patient with a complete septate uterus and duplicated cervices and important related considerations. Case report. This case describes a 33-year-old G2P0201 female, with a history of undergoing a loop electrosurgical excision procedure and longitudinal vaginal septum resection, and who was previously misdiagnosed with a didelphic uterus and duplicated cervices. She had a failed history-indicated transvaginal cerclage placed around the cervix connected to the gravid hemicavity during her second pregnancy and was referred to our practice for transabdominal cerclage placement. A preoperative magnetic resonance imaging scan was performed. (The patient(s) included in this video gave consent for publication of the video and posting of the video online including social media, journal website, scientific literature websites [such as PubMed, ScienceDirect, Scopus, etc.] and other applicable sites.) INTERVENTION: Needleless laparoscopic transabdominal cerclage. Preoperative workup, imaging, and surgical technique. Magnetic resonance imaging scan revealed a complete septate uterus with duplicated cervices. A needleless laparoscopic transabdominal cerclage was placed after careful dissection of the uterine vessels at the level of the internal cervical os and creation of a tunnel medial to them. Nonabsorbable, braided polyester suture was used. Transabdominal cerclage is a feasible alternative in patients with congenital uterine anomalies, as a transvaginal approach might increase the risk of failure. Accurate diagnosis through advanced imaging, multidisciplinary consultation, and individualized surgical planning are key to optimizing reproductive outcomes.

To evaluate surgical outcomes of hysteroscopic metroplasty for complete uterine septa with or without associated cervical anomalies and/or vaginal septa, and to compare reproductive outcomes to determine if the presence of these anomalies affects surgical success and fertility outcomes. multicentre retrospective observational study. 2 university affiliated hospitals in Italy. The study cohort comprised patients with history of primary infertility, recurrent pregnancy loss or severe preterm birth with complete uterine septum with or without cervical and/or vaginal septa anomalies diagnosed on 3D transvaginal ultrasound and hysteroscopy for which they had hysteroscopic metroplasty between January 2020 and May 2023 in either of the 2 participating centres. hysteroscopic metroplasty performed in the operating room under general or loco-regional anesthesia, using either miniaturized instruments (5Fr electrodes or 15Fr bipolar resectoscope) or 27Fr bipolar resectoscopes followed by application of auto-cross-linked hyaluronic acid gel for the prevention of post-operative adhesions. A total of 101 patients were included in our study. We collected perioperative outcomes including operative time, operative complications, ease of the procedure and need for a repeat resection for residual septum. We also explored reproductive outcomes including clinical pregnancy, live birth and miscarriage rates. All surgical procedures were successfully performed without any significant complications. Operative time was shorter and procedures were reported to be easier in patients without cervical anomalies (U2bC0V0). A second surgical resection was required in most cases regardless of the presence of cervical abnormalities. Reproductive outcomes were available for 66 (65.3 %) patients and there were no significant differences in reproductive outcomes between patients with and without cervical/vaginal anomalies. Hysteroscopic metroplasty for complete uterine septum, with or without cervical/vaginal abnormalities is effective and safe. The presence of cervical anomalies doesn't seem to affect the need for a second resection or reproductive outcomes.