Delayed Severe Dysmenorrhea After Tubal Ligation in a Patient With Rudimentary Horn: A Case Report

Abstract

Unicornuate uterus with a non-communicating rudimentary horn is a Mullerian duct anomaly that is unusual among all congenital uterine anomalies. The lesion presents most frequently during childhood and adolescence in an obstructive episode. It is rare in normal reproductive women. Here, we present a patient with a unicornuate uterus and a non-communicating functional rudimentary horn and report laparoscopic therapeutic management for the unicornuate uterus. A 39-year-old woman presented with dysmenorrhea for 6 years after abdominal sterilization. The symptoms worsened and she came to our outpatient department for help. Physical examination and transvaginal ultrasound revealed a left round pelvic mass; the CA-125 level was elevated. Laparoscopy under general anesthesia for suspected chocolate cyst revealed a unicornuate uterus with a non-communicating rudimentary uterine horn. Pathology confirmed myometrium with hematometra and hematosalpinx. The patient recovered smoothly and reported no dysmenorrhea at the follow-up examination 12 weeks after surgery. To the best of our knowledge, tubal sterilization is a simple and easy procedure. However, in women with a unicornuate uterus and non-communicating rudimentary horn with a functional endometrium, we suggest performing ligation of the contralateral tube, leaving the tube on the side of the rudimentary horn alone. This will prevent this rare iatrogenic complication.