Abstract
A unicornuate uterus is a relatively rare Müllerian anomaly with an incidence of 2.5-13%. It may lead to various gynecological or obstetric complications, and diagnosis can often be confusing and delayed. It is associated with varying clinical presentations depending on the presence of functional endometrium, which requires immediate surgical resection on the diagnosis.We report two cases of the unicornuate uterus in young women who presented with severe progressive dysmenorrhoea. These cases highlight the challenges in diagnosing the condition by ultrasound, which was confirmed later by MRI. Both cases were managed by laparoscopic resection of the functional non-communicating uterine horn. On follow-up, both patients were found asymptomatic with normal menstrual cycles.In patients of young age who present with abdominal pain, adnexal masses of unknown origin, and severely painful periods, we should consider Müllerian duct anomalies as one of the differential diagnoses. Early and proper preoperative diagnosis of these cases is essential to prevent complications and to offer adequate treatment. Operative laparoscopy is an excellent alternative to laparotomy for their management, particularly in young unmarried girls.
Highlights
A unicornuate uterus is a relatively rare malformation caused by abnormal or failed development of one of the paired Müllerian ducts, and its incidence has been reported to be 2.5%-13% [1,2]
We report two cases of the unicornuate uterus in young women who presented with severe progressive dysmenorrhoea
Incomplete atresia of a Mullerian duct results in a rudimentary horn, which is broadly connected through a streak of tissue with the unicornuate uterus, and in 74% of the cases, there is no communication between the two endometrial cavities [3,4]
Summary
A unicornuate uterus is a relatively rare malformation caused by abnormal or failed development of one of the paired Müllerian ducts, and its incidence has been reported to be 2.5%-13% [1,2]. Patients are mostly asymptomatic in rudimentary horn with a non-functional and noncommunicating endometrial cavity. A non-communicating horn with a functional endometrial cavity can cause painful menstruation, lump abdomen, and dyspareunia due to hematometra, hematosalpinx, or endometriosis following retrograde menstruation It may be associated with malformations of the upper urinary tract as well [5]. MRI of the abdomen and pelvis was subsequently done, which revealed a unicornuate uterus with a right-side non-communicating horn and hematometra along with a right-side paraumbilical ectopic kidney. Pelvic MRI: T2 signal MRI indicated the presence of the right-side functional rudimentary horn with hematometra in a unicornuate uterus. Both ovaries were demonstrated MRI: magnetic resonance imaging
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