1828 Surgical Management of a Fused Non-Communicating Rudimentary Uterine Horn with Significant Myometrial Connection

Abstract

Video Objective In this video we present the surgical management of a fused non communicating, rudimentary uterine horn with significant myometrial invasion. The objectives of this video are to review the diagnostic imaging features that are suggestive of surgical complexity with non communicating fused rudimentary horn resections. And review the steps involved in their resection. Setting A 12 year old previously healthy female presenting with 8 months of progressively worsening, severe dysmenorrhea. Onset 5 months post menarche. Her pain was not alleviated with ibuprofen, naproxen or acetaminophen. Initial Abdominal & Pelvic US: possible uterine fibroid, unremarkable kidneys. A Repeat US suggestive of a unicornuate uterus with an obstructed left rudimentary horn. She was started on menstrual suppression with a continuous combined oral contraceptive. A MRI was done confirming the presence of a left fused, non communication rudimentary horn, with significant myometrial invasion. Interventions A laparoscopic left uterine horn resection was performed. The surgery was divided into four steps. These include to perform a anatomical survey to confirm the patients anatomy, lateral isolation of hemi-uterus, division of the myometrial connection and finally, myometrial reconstruction. Conclusion In summary, the surgical steps in the management of a fused non communicating rudimentary uterine horn with significant myometrial connection include: To perform a anatomical survey to confirm the patients anatomy, lateral isolation of hemi-uterus, division of the myometrial connection and finally, myometrial reconstruction. A non-communicating functional fused rudimentary horn with significant myometrial invasion can present as a surgical challenge to gynecologists. It is important to do a pre-operative MRI in adolescents or with complex anomalies to assess the complexity of anticipated surgery. Post operative imaging with a MRI can assess for any residual endometrium from the resected horn.