Surgical Approach to a Non-Communicating Uterine Horn

Abstract

<h3>Study Objective</h3> The objective of this video is to discuss and demonstrate a surgical approach to management of a deeply involved non-communicating left uterine horn. <h3>Design</h3> Case Study. <h3>Setting</h3> The patient was taken to the operating room for a planned procedure. Adequate general anesthesia was obtained. She was placed in the dorsal lithotomy position and prepped and draped in usual sterile fashion. <h3>Patients or Participants</h3> 21 y/o G0 presenting with 7 months of worsening dysmenorrhea. <h3>Interventions</h3> Patient underwent a Laparoscopic left uterine horn excision, left salpingectomy, chromotubation, treatment of endometriosis (excision and ablation). <h3>Measurements and Main Results</h3> A saline infusion sonogram was performed for further evaluation of dysmenorrhea which noted a possible uterine horn with endometrial lining. A subsequent MRI was ordered to further delineate anatomy and surgical planning. A non-communicating left uterine horn contiguous with the right unicornuate uterus was seen. The right unicornuate uterus was seen along the entire length communicating with the cervix. Pre-operative renal imaging was performed to assess for simultaneous renal abnormalities which was negative. In patients with mullerian anomalies, a thorough evaluation of the renal collecting system is essential. As high as 40% of patients with a unicornuate uterus are noted to have simultaneous renal anomalies. Pre-operative imaging with an ultrasound or an MRI is warranted to evaluate the kidneys, ureters and bladder. Obstruction is often associated with retrograde menses and hence endometriosis. Superficial scattered endometriosis lesions were noted in the pelvis of this patient. Surgical excision of the non-communications horn can provide symptomatic relief and eliminate reflux. <h3>Conclusion</h3> There are multiple types of mullerian anomalies. Ultrasound imaging is generally the first step in evaluation. if an ultrasound is unclear, an MRI can be ordered to further assess the complex anomaly. Evaluation of the renal collecting system is essential in these patients as the rate of renal anomalies can be high.