Abstract
A 41-year-old woman referred to us with dysmenorrhea and severe pelvic pain although she was previously submitted to right laparotomic adnexectomy for ovarian endometrioma and to a subsequent operative laparoscopy for pelvic adhesions. After ultrasound examination, the patient underwent diagnostic hysteroscopy and operative laparoscopy which confirmed the clinic suspect of an unicornuate uterus. However, it was very unusual to see an extremely distanced right horn, without communication with uterus, without adnexa, and with a small myoma belonging to it. Moreover, omentum and bowel were attached to fundus of right horn and thick adhesions fixed it to rectum and right pelvic wall. Therefore, identification of anatomical structures was difficult, as it was extremely arduous to isolate the ureter, which was involved inside the adhesions surrounding the right uterine horn. Nevertheless, laparoscopic right hemihysterectomy was successfully performed and right horn was sent to our pathologist who recognized hypotrophic endometrium and adenomyosis.
Highlights
Unicornuate uterus is a rare congenital anomaly (2%–10% of all types of uterovaginal anomalies) [1] in which the partial development of the unilateral mullerian duct results in various degrees of rudimentary horn connected or not to the opposite horn
We present a case of a patient for whom diagnosis of uterine horn was missed at prior laparotomy and laparoscopy, which we successfully treated by laparoscopic unilateral hysterectomy for an extremely distant noncommunicating rudimentary fibromatous horn of uterus causing severe pelvic pain
Second ultrasound, performed immediately after an episode of pelvic pain, revealed a right sided cystic mass, filled with low level of homogenous echoes surrounded by a hyperechoic edge, joined to a smaller echoic mass, suggestive for small myoma. It was the sign of a recent hematometra occurred in the noncommunicating fibromatous right horn of the patient’s unicornuate uterus, but the history of two previous surgeries without any mention of the presence of a mullerian malformation made it difficult for us to believe that the diagnosis was exactly this
Summary
Unicornuate uterus is a rare congenital anomaly (2%–10% of all types of uterovaginal anomalies) [1] in which the partial development of the unilateral mullerian duct results in various degrees of rudimentary horn connected or not to the opposite horn. Some mullerian anomalies, including the rudimentary horns of unicornuate uterus, have increasingly been managed by surgical procedures avoiding laparotomy with excellent reproductive outcomes [3]. The experience of any centre is limited by the relative rarity of this particular malformation and for these reasons, diagnosis and management of such types of anomalies are often a challenge for the gynaecologist. We present a case of a patient for whom diagnosis of uterine horn was missed at prior laparotomy and laparoscopy, which we successfully treated by laparoscopic unilateral hysterectomy for an extremely distant noncommunicating rudimentary fibromatous horn of uterus causing severe pelvic pain
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