Noncommunicating Rudimentary Uterine Horn Research Articles

Surgical considerations for resection of a non-communicating rudimentary uterine horn

Surgical considerations for resection of a non-communicating rudimentary uterine horn

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.

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

<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.

Co-Existence of a Rudimentary Non-Communicating Horn with a Unicornuate Uterus in Association with 2 Components of the VACTERL Association: A Case Report

The prevalence of congenital uterine anomalies has been reported as 6.7% in the general population. The unicornuate uterus accounts for 2.4-13% of all Mullerian anomalies and has a prevalence of 1:1000. A unicornuate uterus may be present alone or with a rudimentary horn and 75-90% of rudimentary horns are non-communicating. A pregnancy in the rudimentary horn may lead to uterine rupture, haemoperitoneum with a high risk of maternal mortality. The association of a unicornuate uterus with a non-communicating uterine horn to the VACTERL association of defects (vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies and limb defects) has been described only twice in the literature. We report a patient who was born with an extra thumb and had a trachea-bronchial remnant with oesophageal stenosis that were both operated on earlier, and they were associated with a non-communicating rudimentary uterine horn. To the best of our knowledge, this is the third case reported in the literature of a VACTERL association to a unicornuate uterus with a non-communicating functional rudimentary horn. Given the high risk for the patient if pregnant an early diagnosis is paramount. This case highlights the importance of considering Mullerian defects in the young patient born with components of the VACTERL association.

An unprecedented occult non-communicating rudimentary uterine horn treated with laparoscopic excision and preservation of both fallopian tubes: a case report and review of the literature

BackgroundMüllerian duct anomalies are congenital malformations of the female genital tract and may be of various types. For decades they have been classified according to the American Society of Reproductive Medicine, which mentions unicornuate uterine malformations as the second subgroup. They result from the arrested development of one of the Müllerian ducts and appear in approximately 1/1000 women. These anomalies are usually diagnosed in the second decade of life, because they tend to remain asymptomatic until adolescence and their initial symptoms may vary. Patients present with symptoms such as dysmenorrhea, infertility, and chronic or acute abdominal pain.Case presentationWe report on a 21-year-old Caucasian German patient who suffered from dysmenorrhea for 7 years. After a transvaginal ultrasound and magnetic resonance tomography of the pelvis was performed, the patient underwent a diagnostic hysteroscopy and operative laparoscopy, and was finally diagnosed with a Müllerian duct anomaly presenting with a non-communicating rudimentary uterine horn. The left tube arose directly in orthotopic location from the cornua of uterus, with no connection to the rudimentary uterine horn or structure.ConclusionThe anatomic features of this case have not been reported previously and were not consistent with any existing classification. More cases are needed in order to confirm our hypothesis. Gynecologists should always consider Müllerian anomalies as an important differential diagnosis in young patients with abdominal pain.

腹腔鏡下coring-type resectionを行った非交通性副角子宮の1例

腹腔鏡下coring-type resectionを行った非交通性副角子宮の1例

Management of bicornuate uterus non-communicating rudimentary uterine horn: A case report

Management of bicornuate uterus non-communicating rudimentary uterine horn: A case report

Robotic Resection of a Non-Communicating Right Uterine Horn

Study Objective We present an uncomplicated robotic resection of a uterine horn in a teenage patient to highlight a minimally invasive approach, emphasize the importance of preoperative imaging, discuss potential areas for intraoperative complications, and address the possibility of trial of labor. Design N/A Setting Academic Medical Center - The patient was a 14-year-old nulligravida who presented to the Emergency Room for cyclic, right sided abdominal four months after menarche. The patient was found to have a unicornuate uterus with a functional, non-communicating rudimentary right uterine horn as demonstrated by an MRI obtained with and without contrast. The MRI included examination of the renal system, which was normal in this patient. Patients or Participants N/A Interventions Robotic resection of a non-communicating uterine horn with right salpingectomy. Measurements and Main Results N/A Conclusion Uterine malformations do not always occur in isolation. Given the high incidence of renal tract malformations associated with Mullerian duct anomalies, specifically unicornuate uterus, it is imperative that you obtain preoperative imaging to confirm a normal or abnormal renal system. As far as we are aware, there is not a standardized approach to removal of uterine horns. A minimally invasive approach, whether laparoscopic or robotic, should be the standard of care. Although this case was without complications, due to the unpredictability of these anomalies, a skilled surgeon should be involved with the case, especially one who is prepared to deal with a variety of complications. Additionally, we propose that patients with a history of a non-communicating uterine horn resection without entry in the uterine cavity be given the option for a trial of labor, with caution, similar to myomectomies.

Laparoscopic resection of functional, noncommunicating uterine horn in close approximation to functional hemiuterus

To review the presentation of unicornuate uterus with a functional noncommunicating rudimentary uterine horn and a laparoscopic method of management, highlighting laparoscopic surgical techniques. A video review of unicornuate uterus with a functional noncommunicating rudimentary uterine horn and a laparoscopic approach to treatment in a 13-year-old pubertal female with severe menstrual pain. Tertiary care facility. A 13-year-old G0 was referred to the clinic for severe cyclic right lower quadrant pain during menses. Transvaginal ultrasonography revealed a left unicornuate uterus with a right-sided noncommunicating rudimentary horn measuring 4.8 × 4.7 × 4.6 cm, containing blood consistent with hematometra. Her kidneys were bilaterally present and normal by ultrasonography. Because of the patient's worsening pain and the presence of hematometra, we proceeded with diagnostic laparoscopy and removal of the rudimentary uterine horn. The entire procedure was performed laparoscopically, with an estimated total blood loss of 20 mL. Included are tips for laparoscopic resection and suturing. Pathologic features and postoperative course. The patient's pathologic features were benign, and her severe menstrual pain was resolved. She had no complications or readmissions. In patients with severe menstrual pain from outflow obstruction from a noncommunicating rudimentary uterine horn with functional endometrium, laparoscopic resection can be a safe and effective method of treatment.

A case of unicornuate uterus with a non-communicating rudimentary uterine horn, with adenomyosis, managed with laparoscopic surgery

A case of unicornuate uterus with a non-communicating rudimentary uterine horn, with adenomyosis, managed with laparoscopic surgery

Laparoscopic resection of noncommunicating rudimentary uterine horn with functioning endometrium - report of two cases

A noncommunicating rudimentary uterine horn with functioning endometrium is a congenital Müllerian anomaly known to cause menorrhagia and abdominal pain. Here, we present two patients with a type 2b uterine anomaly (American Society for Reproductive Medicine classification) and successful laparoscopic resection of the rudimentary horn in each.

1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report

Video Objective This video demonstrates the laparoscopic management of a surgical emergency due a non-communicating herniated rudimentary uterine horn and ipsilateral torsed adnexa. Setting NA. Interventions This case is a 36-year-old healthy woman undergoing elective oocyte cryopreservation with normal baseline pelvic ultrasounds. On day 7 of oocyte stimulation, an enlarging inguinal mass was identified associated with severe inguinal pain; an incarcerated ovary was suspected. She was taken to the operating room for surgical management. The diagnosis of a Mullerian anomaly was made laparoscopically, noting that she had a right unicornuate uterus with associated normal-appearing right adnexa and ureter. Notably, the left non-communicating rudimentary uterine horn was found herniated through the deep inguinal ring, drawing with it a portion of the left tube and ovary, torsed around its associated pedicle. A left ureter could not be visualized. After decompressing and de-torsing the left inguinal mass, the rudimentary horn, fallopian tube, and necrotic portion of the left ovary were excised using a bipolar sealing device; the inguinal hernia was repaired. The viable left ovarian tissue was retained. A postoperative renal ultrasound confirmed left renal agenesis. Two months later, she successfully underwent oocyte cryopreservation with eggs aspirated from both ovaries. Conclusion Hernia uterus inguinale is a rare condition in which uterine tissue and occasionally adnexa herniate through the inguinal ring. It can present as an asymptomatic palpable mass or rarely as pelvic pain. Most reports have focused on its association with persistent Mullerian duct syndrome, which affects phenotypically male infants. While there are few reports of hernia uterus inguinale occurring in adult females, this case highlights the importance of keeping it in the differential in a patient with an inguinal mass and recognizing the potential for its associated morbidity and the ability to manage it surgically, if needed, through a minimally invasive approach.

1828 Surgical Management of a Fused Non-Communicating Rudimentary Uterine Horn with Significant Myometrial Connection

Video Objective In this video we present the surgical management of a fused non communicating, rudimentary uterine horn with significant myometrial invasion. The objectives of this video are to review the diagnostic imaging features that are suggestive of surgical complexity with non communicating fused rudimentary horn resections. And review the steps involved in their resection. Setting A 12 year old previously healthy female presenting with 8 months of progressively worsening, severe dysmenorrhea. Onset 5 months post menarche. Her pain was not alleviated with ibuprofen, naproxen or acetaminophen. Initial Abdominal & Pelvic US: possible uterine fibroid, unremarkable kidneys. A Repeat US suggestive of a unicornuate uterus with an obstructed left rudimentary horn. She was started on menstrual suppression with a continuous combined oral contraceptive. A MRI was done confirming the presence of a left fused, non communication rudimentary horn, with significant myometrial invasion. Interventions A laparoscopic left uterine horn resection was performed. The surgery was divided into four steps. These include to perform a anatomical survey to confirm the patients anatomy, lateral isolation of hemi-uterus, division of the myometrial connection and finally, myometrial reconstruction. Conclusion In summary, the surgical steps in the management of a fused non communicating rudimentary uterine horn with significant myometrial connection include: To perform a anatomical survey to confirm the patients anatomy, lateral isolation of hemi-uterus, division of the myometrial connection and finally, myometrial reconstruction. A non-communicating functional fused rudimentary horn with significant myometrial invasion can present as a surgical challenge to gynecologists. It is important to do a pre-operative MRI in adolescents or with complex anomalies to assess the complexity of anticipated surgery. Post operative imaging with a MRI can assess for any residual endometrium from the resected horn.

721 - Laparoscopic Management of a Functioning Non-Communicating Rudimentary Uterine Horn

721 - Laparoscopic Management of a Functioning Non-Communicating Rudimentary Uterine Horn

Robotic Assisted Resection of a Non-Communicating Uterine Horn Ectopic Pregnancy

Abstract Background: Anomalies of the female reproductive tract have been associated with poor pregnancy outcomes. In the case of an ectopic pregnancy, these risks are especially high. Case: A 29-year-old, gravida 1 female with a pregnancy at 9 weeks' gestational age, who presented for care, was found to have a uterine-horn ectopic pregnancy. Imaging confirmed the presence of a unicornuate uterus with the pregnancy located in a noncommunicating uterine horn. Excision of the ectopic pregnancy was recommended, and the patient underwent a robotic assisted resection of the noncommunicating rudimentary uterine horn and the pregnancy. Results: There were no postoperative complications. The patient's pathology was consistent with a tubal/cornual ectopic pregnancy. She stated that she would like to conceive in the future. Any future pregnancies in this patient will need to be monitored closely because of her risk of a higher complication rate. Conclusions: This is the first reported case describing a robotic appr...

Unembriyonic pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report

This is a case report of an unembriyonic pregnancy in the non-communicating rudimentary horn of a unicornuate uterus with the contralateral ovary carrying a corpus luteum. A 24-year-old nullipara was admitted to our outpatient clinic with the complaint of primary infertility for 3 years. Her hysterosalpingographic and laparoscopic evaluation revealed a mullerian anomaly; non-communicating rudimentary uterine horn. One year later, the patient was admitted with a 10-week amenorrhea. The examination showed unembriyonic pregnancy in the left uterine rudimentary horn and corpus luteum on the contralateral ovary. The case at hand is an evidence of transperitoneal migration of both the sperm and the ovum, so the belief that unicornuate uterus with a non-communicating rudimentary horn goes asymptomatic without causing any trouble is not true. In such cases, the rudimentary horn should be removed.

Laparoscopic Management of Ectopic Pregnancy in Non-Communicating Rudimentary Uterine Horn

Pregnancy within a rudimentary uterine horn is an extremely rare event but has been reported to occur in approximately 1 in 76,000 to 1 in 150,000 pregnancies. Of these gestations, 80-90% involve a non-communicating rudimentary horn.

Pregnancy in a non‐communicating rudimentary uterine horn in an obese woman

Pregnancy in a non‐communicating rudimentary uterine horn in an obese woman

Remnant Functioning Cervical Tissue After Laparoscopic Removal of Cavitated Noncommunicating Rudimentary Uterine Horn

Cavitated noncommunicating rudimentary uterine horn is managed via surgical removal. During the past 20 years this has been performed primarily via laparoscopy. At our multidisciplinary specialized center, this condition has been treated in 29 patients over 10 years. Three patients had pelvic pain and recurrent symptoms of menstrual obstruction at 2, 5, and 6 years after the initial operation. Magnetic resonance imaging revealed blood-filled pelvic masses at the site of the previous procedures. After laparoscopic removal of these masses, histologic analysis confirmed the presence of remnant functioning cervical tissue. This is the first report of long-term follow-up of patients with a history of obstructed rudimentary uterine horn to demonstrate that complications can occur several years after such operations. It is essential that any reports of recurrent pain should be considered seriously and investigated.

Non-communicating Rudimentary Uterine Horn Pregnancy

Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confirmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature.