Laparoscopic Management of a Non-Ruptured Ectopic Pregnancy in a Rudimentary Uterine Horn

Abstract

<h3>Study Objective</h3> To describe the successful laparoscopic management of a non-ruptured ectopic pregnancy with cardiac activity in a rudimentary uterine horn. <h3>Design</h3> Case report. <h3>Setting</h3> Operating room, tertiary care facility. <h3>Patients or Participants</h3> 30-year-old gravida 5, para 1, abortion 3 who presented with a 7-week ectopic pregnancy with cardiac activity in a non-communicating rudimentary uterine horn. Beta hCG level was 22,504 mIU/mL. <h3>Interventions</h3> Laparoscopic exploration revealed a left-sided unicornuate uterus with normal left-sided adnexa, and a right rudimentary horn on a 3 cm stalk enlarged and engorged with ectopic pregnancy. The right fallopian tube was removed up until the level of the rudimentary horn using a vessel sealing device. A barbed suture was then anchored medial to the stalk prior to resection. The stalk of the right rudimentary horn was then desiccated and divided using the vessel-sealing device. Bleeding was noted at the base of the stalk, so the previously anchored barbed suture was then utilized to do a 2-layer laparoscopic closure across the base. The specimen was removed using a tissue extraction bag. Total blood loss was 20cc, and patient was discharged the same day. Pathology confirmed rudimentary horn with myometrial implantation site and chorionic villi consistent with ectopic pregnancy. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> This is a unique case of laparoscopic management of a rudimentary uterine horn ectopic pregnancy with cardiac activity. Most cases reported in the literature thus far involve medical management with interval surgery. When immediate surgical management has been described for non-ruptured ectopic pregnancies in rudimentary horns, it has been in cases with lower beta hCG levels and fetuses without cardiac activity. Laparotomy has been a common approach for excision of rudimentary horns, however laparoscopy has been shown to be effective. This case highlights that laparoscopic management of an advanced non-ruptured ectopic pregnancy in a rudimentary horn is safe and feasible.