Non-Communicating inactive rudimentary horn of the uterus presenting with dysmenorrhoea—a case report of successful laparoscopic excision

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.