Excision Of Rudimentary Horn Research Articles

Acute maternal collapse in pregnancy with ruptured rudimentary horn of unicornuate uterus: A case report

Unicornuate uterus with rudimentary horn occurs due to failure of complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. It is associated with numerous obstetrics and gynecological problems such as Infertility, Endometriosis, Miscarriages, Malpresentations & Intrauterine growth restriction. Pregnancy in the non-communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy. Pregnancy occurs via transperitoneal migration of sperm or zygote. Variable thickness of rudimentary horn musculature, poor distensibility of myometrium lead to rupture. This complication is usually seen in 2nd trimester resulting in shock and haemoperitoneum. Diagnosis of rudimentary horn pregnancy is difficult and can be missed in ultrasound. It requires a high risk of suspicion. Materials and Methods: We report the case of 24yr primi gravida with 26 weeks of gestation presented with pain abdomen and sudden maternal collapse on arrival, suspected to be intra-abdominal pregnancy in ultrasound and on laparotomy found ruptured rudimentary horn of unicornuate uterus with fetus found intra-abdominally with massive hemoperitoneum. Conclusion: Pregnancies in rudimentary horn of unicornuate uterus are prone to intra uterine growth restriction and rupture in second trimester so a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during non-pregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.

Un caz rar operat de sindrom OHVIRA cu un pseudochist

Obstructed hemivagina with ipsilateral renal agenesis (OHVIRA) syndrome – also known as Herlyn-Werner-Wun­der­lich syndrome – is a rare Müllerian anomaly. It was de­scribed first in 1992 by Wilson. Uterine anomalies can range from mild seg­men­tal abnormalities to unicornuate, bi­cor­nua­te, didelphic ute­rus and even the absence of uterus and vagina. Among the most common renal ano­ma­lies, there are renal agenesis, renal ec­to­py, multi­cystic dysplastic kidney and renal duplication. We pre­sent the case of a 26-year-old nulligravida with OHVIRA syn­drome, previously operated for rudimentary horn excision, diag­nosed with vaginal pseudocyst.

Reproductive Outcome of the Patients with Uterus Unicornis: Five Year Experience in a Tertiary Center.

The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center. Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited into this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period. Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Twelve (85.7%) patients had a live birth (71.4% term delivery, 21.4% preterm delivery), and two (15.3%) had a first-trimester spontaneous abortion. Six (50%) of 12 patients who had a live birth received tocolytics for preterm labor. Unicorn uterus is a rare anomaly diagnosed mostly during infertility work-up and might be related to the poor obstetric outcome, but early diagnosis is important for successful pregnancy results for preterm delivery especially in the secondary infertile group. In addition, rudimentary horn excision is recommended due to the high risk of obstetric complications.

A Study of Pregnancy in a Non-Communicating Rudimentary Horn of the Uterus

BACKGROUND
 Pregnancy in a non-communicating horn of the uterus is a very rare entity. Incidentally, we had 11 cases in the last 6 years presenting in various ways. In literature, cases presented on pregnancy in a non-communicating horn are not many. Hence we are analysing our cases. The objectives of our study were to diagnose and manage such cases at the earliest and sharing our experience to help for its early diagnosis and further management.
 METHODS
 Records of women diagnosed with ectopic pregnancy in the rudimentary horn, during the last 6 years, were reviewed for their diagnostic difficulties and the associated morbidity.
 RESULTS
 Cases diagnosed before laparotomy were 3, and cases diagnosed after laparotomy were 8. Amongst 8 cases, 2 were intact and the other 6 had already ruptured. Laparotomy with excision of rudimentary horn and salpingectomy was done in all cases.
 CONCLUSIONS
 Suspicion is the main tool for diagnosis. Its suspicion and clinical finding along with imaging technology are very important for its early diagnosis and management.

Non-communicating rudimentary uterine horn: overview and surgical excision technique

To present principles and techniques for safe and efficient laparoscopic excision of a rudimentary non-communicating rudimentary horn. Laparoscopic surgery of a non-communicating rudimentary uterine horn is effective in treating patients with this anomaly. This video will give an overview of a rudimentary uterine horn and review fundamental principles for safe and effective surgical removal of the defect. A 34-year-old female presents with a history of pelvic pain and endometriosis. She was previously diagnosed with a unicornuate uterus with a non-communicating rudimentary horn. The fundamental principles for safe and effective excision of a non-communicating rudimentary horn include: Accurate diagnosis of rudimentary horn via imaging, hysteroscopy, and laparoscopy. Understanding that Mullerian anomalies have a propensity for pelvic pain and endometriosis, therefore a pelvic survey should be completed. Methylene blue can be helpful to surgeons during rudimentary horn excision because it guides surgeons during the surgery and can notify the surgeon when the uterine cavity has been entered. Methylene blue also helps assess the anatomy and functionality of the fallopian tubes during a Mullerian horn resection. Vasopressin should be considered during uterine horn resection to help minimize blood loss. Identifying the location of the uterine vessels in relation to the uterine horn dissection is essential. Preservation of the uterine vessels is optimal, when possible, especially in women who desire future fertility. Reapproximation of anatomy should be attempted to stabilize anatomy and reduce the risk of ovarian torsion. When performing an excision of a rudimentary horn, a surgeon should remember these operative techniques for a safe and efficient procedure. A rudimentary horn is a lateral fusion defect and can be safely excised if one understands the surgical methods.

Congenital genital tract obstruction as a challenge for functioning reproductive health: a study from a tertiary care center in Nepal

Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction and successes achieved in its management.
 Methods: This was a descriptive study done at department of Obs/Gyn at Tribhuvan University Teaching Hospital from April 2014 to April 2018. Types of genital tract obstruction, surgical treatment, success of management and surgical complications were studied.
 Results: Of 35 cases 16 (46%) consisted of adolescents aged 11-15 yrs. Majority cases of GTO was due to vaginal septum 12(34%): longitudinal 4(33%), mostly transverse vaginal septum (TVS) 8(67%): upper TVS 4 and lower TVS 4,one among each associated with concurrent Imperforate hymen (IH). Other GTO consisted of only IH cases 9 (26%), vaginal agenesis 7 (21%), non- communicating rudimentary horn 4 , non-communicating right cornua 1and cervical stenosis 1(3%). Resection of septum performed in 12 cases of vaginal septum. hymenectomy in 8 and rudimentary horn excision in 4 cases. Restenosis was common complication in six cases.
 Conclusions: Adolescent age of 11-15 years is the common age of presentation of genital tract anomaly with vaginal septum the most common. Pre-surgical assessment is the key to successful surgical outcome.
 Keywords: adolescent, congenital, genital tract obstruction, resection

2728 Robotic Assisted Excision of a Uterine Rudimentary Horn

Video Objective The objective of this video is to portray a robotic assisted removal of a uterine rudimentary horn and excision of endometriosis in a patient with a Mullerian anomaly and dysmenorrhea. Setting The patient is a 32 year old G2P1001 who presented with a 6 month history of worsening dysmenorrhea with multiple emergency department visits secondary to pain. Patient has a history of a prior uncomplicated full-term delivery via cesarean section 1 year prior and a laparoscopic appendectomy, with a different provider, where a right salpingo-oophorectomy was performed. The patient reported her dysmenorrhea became severe after the latter surgery. She first underwent a diagnostic hysteroscopy and laparoscopy where she was diagnosed with a unicornuate uterus with a right rudimentary horn. The hysteroscopy was significant for one cervix with passage to one uterine cavity with good visualization of the left ostia, right ostia was not visualized. The diagnostic laparoscopy showed a wide appearing uterus with two definite uterine bodies. The right side appeared to be a redundant fundus with a myoma appearance, the left adnexal structures appeared normal, the right adnexal structures were surgically absent. Chromotubation was performed and the left fallopian tube was patent. Interventions Patient underwent a robotic assisted removal of the uterine rudimentary horn from a unicornuate uterus. The dissection was performed meticulously with care to excise the rudimentary horn without compromise to the right uterine vasculature or the unicornuate cavity. Hysteroscopy was then performed to confirm the integrity of the unicornuate cavity. Conclusion We hypothesize that after removal of the right fallopian tube retrograde menstrual flow was blocked and caused her severe dysmenorrhea. After the excision of the rudimentary horn the patient's pain improved and went on to naturally conceive an intrauterine pregnancy. The Patient is currently in her second trimester.

A surprising presentation of a partial hydatidiform molar pregnancy in rudimentary horn of unicornuate uterus

A surprising presentation of a partial hydatidiform molar pregnancy in rudimentary horn of unicornuate uterus - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.087, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Intractable Dysmenorrhea in Adolescent: A Series of Two Cases of Laparoscopic Rudimentary Horn Excision

Intractable Dysmenorrhea in Adolescent: A Series of Two Cases of Laparoscopic Rudimentary Horn Excision

A Stepwise Approach to Laparoscopic Excision of a Noncommunicating Rudimentary Horn

Study ObjectiveTo demonstrate our approach to laparoscopic excision of a noncommunicating rudimentary horn (AmericanSociety for Reproductive Medicine classification II(b), European Society of Human Reproduction and Embryology/European Society of Gynaecological Endoscop classification class U4a). DesignTechnical video (Canadian Task Force classification level III). SettingUniversity Hospital. PatientA 25-year-old women with a left-sided pelvic mass. InterventionLaparoscopic excision of noncommunicating rudimentary horn with hysteroscopy and cystoscopy. Institutional Review Board/Ethics Committee ruled that approval was not required for this study. Measurements and Main ResultsNoncommunicating rudimentary horns are present in 20% to 25% of women with a unicornuate uterus [1]. Noncommunicating rudimentary horns may be associated with dysmenorrhea, pelvic pain, subfertility, and poor obstetric outcomes. Laparoscopic excision of rudimentary horns can be challenging and complex. Factors to consider in relation to the rudimentary horn are attachment to the uterus, presence and course of the ureter, and vascular supply. In this video we demonstrate our approach to laparoscopic excision of a rudimentary horn including preoperative imaging to plan surgical care. A 25-year-old women presented with pelvic pain and underwent a laparotomy for a left-sided pelvic mass. Intraoperatively, a rudimentary horn was suspected, and she was started on a gonadotropin-releasing hormone analogue pending diagnostic imaging and definitive surgery. Computed tomography demonstrated an absent left kidney and ureter. Intraoperatively, we began with a cystoscopy to identify and confirm an efflux from ureteral openings. A real-time hysteroscopy was performed to identify the unicornuate uterus from the rudimentary horn and to exclude vaginal or cervical anomalies. Through hysteroscopic transillumination the plane of dissection was identified between the rudimentary horn and uterus [2,3]. This technique is especially useful when the rudimentary horn is densely fused to the unicornuate uterus. Retroperitoneal dissection was performed ipsilateral to the rudimentary horn. A lateral approach was used to coagulate the uterine artery at its origin. The bladder was reflected from the horn to allow excision. A Thunderbeat device (Olympus Medical Systems, Tokyo, Japan) was used to excise the rudimentary horn, keeping very close to the specimen to ensure no penetration of the unicornuate uterus. Hemostasis was achieved, and no additional sutures were required. The specimen was removed using in-bag morcellation. ConclusionA stepwise hysteroscopic and laparoscopic approach can be used to safely resect a rudimentary horn as demonstrated by this case.

First Case of Mole in the Horn

A 31-year-old (G3P1L0A1 [gravida 3, para1, living 0, abortion1]) woman presented with a molar pregnancy in the rudimentary horn of a unicornuate uterus. Magnetic resonance imaging was consistent with a molar pregnancy in the rudimentary left horn. Her beta–human chorionic gonadotropin (hCG) to 38,000 mIU/ml the next day and 1,100mIU/ml after 1 week. Hysteroscopy revealed a single cervix with a tubular cavity. The right ostium was clearly visualized (Fig. 1A). The left ostium was not seen. Just beyond the internal os on the left side, an opening was seen, which could have been the communication with the left horn (Fig. 1B). Laparoscopy revealed a unicornuate uterus with a 5 × 5 cm left rudimentary horn (Fig. 2A). The bilateral tubes and ovaries were normal. Rudimentary horn excision was performed (Figs. 2B-D). The specimen was retrieved within an indigenous glove endobag by mechanical morcellation through extension of the left lateral port. There was no spillage. The specimen showed multiple vesicles (Fig. 3A). The patient's beta-hCG dropped to 38,000 the next day and 1,100 after 1 week. It was not detectable after 4 weeks. Histopathological examination of the specimen showed a complete mole (Fig. 3B). She was followed up for 6 months with beta-hCG, which was not detectable. The present case is the first case of a molar pregnancy in the rudimentary horn managed by laparoscopic hemihysterectomy. Endobag retrieval is important without any spillage in the peritoneal cavity or the port site. Follow-up is essential to detect rising or plateauing of beta-hCG, which could indicate gestational trophoblastic neoplasia. Fig. 2Laparoscopy. (A) The unicornuate uterus with a left rudimentary horn. (B) The left round ligament, mesosalpinx, and ovarian ligament cauterized and cut. (D) The uterus with the bilateral ovaries at the end of the procedure. (C) The fibromuscular stalk cauterized and cut. View Large Image Figure Viewer Download Hi-res image Fig. 3(A) Vesicles within the horn. (B) Villus distended with stromal fluid and cistern formation (trophoblastic proliferation). View Large Image Figure Viewer Download Hi-res image

Laparoscopic approach to adnexal mass in adolescents: A retrospective analysis

Background: Adnexal masses result from benign or malignant lesions of ovarian, tubal and paratubal origin as well as pregnancy related causes such as mullerian anomalies, infectious causes and ectopic pregnancy. The current study aimed to evaluate the preoperative diagnosis, surgical procedure and histopathological findings of adolescent girls who underwent laparoscopic surgery for adnexal mass in our hospital. Materials and Methods: A retrospective chart review of patients with adnexal mass was conducted over a period of one year from Jan 2014-2015. Overall 96 patients were included in the study after reviewing clinical records. In all the patients' malignancy was excluded by preoperative imaging with sonography, CT or MRI and tumor marker study. Results: Laparoscopy was the operative approach for all 96 patients. None resulted in malignant histology. Majority of the adnexal masses were simple cyst (28%), 11.4% were dermoid cyst, 2% were endometriotic cyst. One patient had tubal ectopic, 3 patients had Koch's abdomen and pelvis. Among them one 13 year old girl underwent rudimentary horn excision who presented as a para tubal mass with acute abdomen. Almost half of the patients (68.7%) presented with acute abdomen of which 41.6% were adnexal torsion. All adnexal masses were resected laparoscopically and the outcome was uneventful in all the patients. Conclusion: Laparoscopy is regarded as an appropriate surgical method for benign adnexal masses which was safe and effective even for giant ovarian cyst in well selected cases as most of the pelvic adnexal masses seen in adolescents and young girls are of benign nature.

A Case of Recurrent Rudimentary Horn Ectopic Pregnancies Managed by Methotrexate Therapy and Laparoscopic Excision of the Rudimentary Horn.

This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn.

Rudimentary Horn Pregnancy: A Rare First Trimester Acute Presentation

Introduction: Rudimentary horn pregnancy (RHP), an entity with a diagnostic dilemma is known to rupture most commonly in second trimester, sometimes in early third trimester. This case of ectopic rudimentary horn (RH) presented acutely in the first trimester. Case Presentation: A 30 years old G 3 P 2 L 2 with previous two vaginal deliveries presented with acute abdominal pain and features of hemorrhagic shock at 8 weeks 5 days gestational age. With clinical diagnosis of ruptured ectopic pregnancy, the patient immediately underwent laparotomy, which revealed hemoperitoneum with a unicornuate uterus along with ruptured RHP. RH excision with ipsilateral salpingectomy and right tubal ligation was done and the maternal life salvaged. Conclusion: High index of suspicion based on clinical history and examination complemented with diagnostic radiological modalities can help in prenatal and pre-rupture diagnosis of RHP, hence its prompt treatment to alleviate scope of any emergency

Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو

A unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side. Pregnancy in a rudimentary horn of the uterus is a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. Usually the diagnosis is missed and may present as an emergency with haemoperitoneum. The standard treatment is the surgical excision of the horn. A gravida 2, para 1 patient presented at 23 weeks' gestation with fetal demise. Repeated failed attempts at induction of labour raised the suspicion of an abnormally located pregnancy which was confirmed by magnetic resonance imaging. She underwent a laparotomy with right rudimentary horn excision. The final diagnosis of a non-communicating rudimentary horn pregnancy was made intraoperatively and was confirmed by histopathology. This case highlights the importance of an early ultrasound in detecting uterine anomalies and the need for high clinical suspicion.

Examination of the Ovarian Reserve after Generation of Unilateral Rudimentary Uterine Horns in Rats

Objective. The purpose of this experimental rat model study is to evaluate the changes in the ovarian environment after excision of the rudimentary horn. Methods. Ten female Wistar albino rats were used in this study. One cm of right uterine horn length was excised in the first operation. Two months after the first operation, all animals were sacrificed to obtain ovaries for histological examination. Mann-Whitney U test and Student's t-test were used for statistical analysis purposes. Statistical significance was defined as P < 0.005. Results. The number of primordial follicles (P = 0.415), primary follicles (P = 0.959), preantral follicles (P = 0.645), antral follicles (P = 0.328), and Graafian follicles (P = 0.721) was decreased and the number of atretic follicles (P = 0.374) increased in the right ovarian side. Howeve,r this difference was not found to be statistically significant. Conclusion. The results of this experimental rat model study suggest that the excision of rudimentary horn could have negative effects on ipsilateral ovarian functions.

Non-Communicating Rudimentary Horn Ectopic Pregnancy

Given the potential for rupture or subsequent recurrence, consideration for rudimentary horn excision should be made in cases of rudimentary horn ectopic pregnancy. With advances in laparoscopic technique, this method is being utilized more commonly to excise rudimentary horn ectopic pregnancies in place of traditional laparotomy.

Ruptured Noncommunicating Rudimentary Horn Pregnancy at 19 Weeks with Previous Cesarean Delivery: A Case Report

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 19 weeks in a woman with previous Cesarean delivery. She had a routine malformation scan in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during nonpregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.

Laparoscopic Management of a Ruptured 16 Week Rudimentary Horn Pregnancy — A Video Presentation

Study Objective: Pregnancy in a rudimentary horn is rare and occurs 1 in 75,000 – 150,000 pregnancies. The most significant threat of pregnancy in a rudimentary horn is the risk of rupture and life threatening haemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of rudimentary horn along with the pregnancy and the ipsilateral tube. We present a case of 16 week ruptured rudimentary horn pregnancy, diagnosed intra-operatively and managed laparoscopically in the presence of massive haemoperitoneum.Although the traditional approach is laparotomy, laparoscopy can provide rapid diagnosis and control of bleeding.

Rudimentary uterine horn pregnancy: a mystery diagnosis

To emphasize the importance of complete ultrasonographic evaluation during the first trimester of pregnancy. Case report. Obstetric unit in a training and research hospital. A 27-year-old primigravida woman who reached 37 weeks' gestation with a noncommunicating rudimentary horn pregnancy. The accurate diagnosis of a noncommunicating rudimentary horn pregnancy was made after cesarean section at 37 weeks' gestation. Rudimentary horn excision and ipsilateral salpingectomy were performed during exploration. Early diagnosis using sonography to prevent maternal morbidity and mortality. A female baby with a 7/10 apgar score was delivered successfully. The patient and her baby were both discharged in good health. Rudimentary uterine horn pregnancy should always be considered as a differential diagnosis of intrauterine pregnancy in a bicornuate uterus. A thorough ultrasonographic examination should be performed on the aspects of the pregnancy and the pelvic anatomy. Lack of knowledge of and experience with müllerian anomalies still makes these anomalies difficult to recognize even with laparoscopy.