Abstract
Uterine developmental abnormalities can cause both obstetric and gynaecological complications. Non-functioning rudimentary uterine horn is a rare cause of dysmenorrhoea which usually starts after menarche. Cases with lateral/inferior arrangement of blood supply to the functioning rudimentary horn and lapascopic removal have been described in literature. Ours is a unique case of non-functioning rudimentary horn with an unusual medial arrangement of vasculature successfully treated by laparoscopic excision. We also present a brief review of the literature. The patient presented with irretractable dysmenorrhoea despite hormonal manipulation and analgesics. Following the diagnosis using laparoscopy and hysteroscopy and MRI, the left sided non-communicating rudimentary horn with inactive endometrium was removed laparoscopically. Her symptoms were resolved and this was followed by successful pregnancies. Diagnosis of rudimentary horn with inactive endometrium is difficult. Ultrasound is unreliable. MRI, 3D CT scan and 3D ultrasound are gaining popularity. Accurate, prior identification of the type using laparoscopy and hysteroscopy if necessary is essential. This helps in surgical planning. The laparoscopic approach is increasingly being used to resect these horns due to its safety and merits.
Highlights
Congenital uterine anomalies result from arrested development of one or both of the Mullerian ducts and/or their defective fusion
Non-functioning rudimentary uterine horn is a rare cause of dysmenorrhoea which usually starts after menarche
Ours is a unique case of non-functioning rudimentary horn with an unusual medial arrangement of vasculature successfully treated by laparoscopic excision
Summary
Congenital uterine anomalies result from arrested development of one or both of the Mullerian ducts and/or their defective fusion. In 80% - 90% of cases, there is no communicating channel between the two uterine cavities [1]. There are many cases reported with non-communicating rudimentary horn and the functioning endometrium associated with various complications such as dysmenorrhoea, adenomyosis, ectopic pregnancy and haematometra [2,3]. There are several in literature, treated with laparoscopic excision where the blood supply of the rudimentary horn was either lateral or inferior [4]. To our knowledge, there are no case reports of unicornuate uterus and a non-communicating rudimentary horn with an inactive endometrium presenting with unilateral dysmenorrhoea. We report a case of an 18 year old girl who presented with primary cyclic spasmodic dysmenorrhoea which was relieved after laparoscopic excision of type 3 rudimentary horn. The vessels were arranged medially and the endometrium was non-functioning
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