Noncommunicating Uterine Horn Research Articles

Unification and orificing of two functional noncommunicating uterine horns through the created neovagina using peritoneum

ObjectiveTo demonstrate the surgical approach for Müllerian agenesis with bilateral uterine remnants containing functional endometrium. DesignStepwise demonstration of the technique with narrated video footage SettingA Tertiary University Hospital, Reproductive Surgery Unit. PatientAn 18-year-old adolescent was admitted to a tertiary university hospital with complaints of primary amenorrhea and cyclic pelvic pain. Physical examination and MRI scans suggested a complex Müllerian abnormality. The patient had uterine remnants with bilateral functional endometrium and cervico-vaginal agenesis. InterventionAn operation was planned to reconstruct her anatomy by providing a neovagina and anastomosing the uterine remnants. GnRH analogs were prescribed to suppress her menstruation until the procedure. The operation was performed in the third month after the initial diagnosis. A laparoscopy was conducted, revealing approximately 5x6 cm bilateral uterine horns with healthy adnexa.As the first step, a neovagina was created using a modified peritoneal pull-down technique, a standard approach in our clinic. A vaginal incision was made, and a blind vaginal dissection was performed to reach the peritoneum vaginally. Subsequently, an acrylic vaginal mold was inserted. The vaginal orifice was laparoscopically incised using ultrasonic energy with guidance from the inserted vaginal acrylic mold. The orifice was gradually dilated with larger molds. The entire pelvic peritoneum was dissected circularly, and the distal part of the dissected peritoneum was pulled down using four 2.0 Vicryl sutures at 0, 90, 180, and 270 degrees from the opened vaginal orifice. The uterine cavities of both remnants were incised, and two separate Foley catheters were placed in both cavities. A mold with a hole was used to insert the catheters through the vagina. Both catheters were secured in the cavities with Prolene sutures pulled up from the anterior abdominal wall.The next step involved uterine anastomosis. The uterine remnants were unified through continuous suturing, resulting in the formation of a normally shaped uterus. In the final step, the created uterus and neovagina were anastomosed. The patient received instructions on how to perform mold exercises and follow-up care. Main Outcome MeasureDescription of a laparoscopic management of a rare mullerian abnormality. ResultsThe postoperative MRI scan at one month revealed healed unified uterine cavities and vagina. The patient experienced spontaneous menstruation in the second month after surgery and now maintains regular menses with an approximately 9-10 cm functional vagina. Within three months after surgery, the VAS (visual analog scale) scores for chronic pelvic pain and dysmenorrhea decreased from 9 to 2-3. ConclusionsMüllerian abnormalities are exceptionally rare, and their spectrum is broad, making it challenging to identify an exact surgical method to restore functional anatomy. Therefore, a customized surgical approach should be designed for each patient based on their unique condition.

Uterine Rupture: Fifteen Weeks of Noncommunicating Uterine Horn Pregnancy

Uterine Rupture: Fifteen Weeks of Noncommunicating Uterine Horn Pregnancy

Unicornuate Uterus with a Non-Communicating Rudimentary Horn in a Palestinian Patient with Familial Mediterranean Fever: Case Report

Rudimentary non-communicating functional uterine horn with unicornuate uterus, originating from anomalous embryological development of one Mullerian duct, is prone to different complications either at the gynecological or obstetrical level such as chronic pelvic pain, hematometra, subfertility and decreased quality of life. This unique case report presents a 14-year-old female with a history of severe chronic pelvic pain. She was diagnosed with Familial Mediterranean Fever (FMF) and had an appendectomy for suspected appendicitis within the symptoms’ interval. Ultrasound showed a right 5*6 cm right complex cystic mass assuming ovarian in place. She underwent a suspected endometrioma cystectomy operation and was diagnosed with left unicornuate uterus with right functional non-communicating rudimentary horn. The patient was followed up and mentioned marked improvement of her previous pain attacks. Her family members observed marked improvement in her usual daily activities and quality of life. Occult non-communicating uterine horn are frequently misdiagnosed due to its rarity and unspecific symptoms. The diagnosis of Mullerian anomalies should be added to the differential diagnoses for women with infertility, chronic abdominal and pelvic pain, and dysmenorrhea to avoid the patients’ agony and to alleviate their quality of life.

46. Mucin Filled Retroperitoneal Mass 4 Years After Removal of Obstructed Noncommunicating Uterine Horn in an Adolescent Patient: a Clinical Case Report

46. Mucin Filled Retroperitoneal Mass 4 Years After Removal of Obstructed Noncommunicating Uterine Horn in an Adolescent Patient: a Clinical Case Report

Resection of a cavitated non-communicating uterine horn with a unicornuate uterus

Resection of a cavitated non-communicating uterine horn with a unicornuate uterus

8356 Robotic Surgery: Pelvic Mass Excision, Resection of Non-Communicating Uterine Horn, and Fulguration of Endometriosis

<h3>Study Objective</h3> To demonstrate surgical techniques for approaching an advanced case of endometriosis in a patient with a congenital uterine anomaly, large pelvic mass, and severe adhesive disease. <h3>Design</h3> A step-by-step explanation of the surgery. <h3>Setting</h3> Community Based Teaching Hospital, Operating Room. <h3>Patients or Participants</h3> 33-yo G0 with known unicornuate uterus with non-communicating uterine horn, dysmenorrhea, suspected endometriosis, infertility, congenital absence of right kidney. <h3>Interventions</h3> Chromotubation was first performed to evaluate if the patient had patent fallopian tubes. The pelvic mass was then decompressed and drained revealing multiple right ovarian cysts. Anatomical landmarks were identified with a retroperitoneal dissection and extensive lysis of adhesions. The bladder was backfilled intermittently to help identify surgical planes. A Keith needle was temporarily placed in the abdomen to elevate the pelvic mass and aid in visualization. The pelvic mass and non-communicating uterine horn were resected. Hemostasis was achieved with electrocautery and suturing. Endometriotic implants in the pelvis and diaphragm were fulgurated and an appendectomy was performed due to extensive damage from endometriosis. All specimens were placed in a bag and removed through the umbilical port site. Post-operatively, the patient was started on progesterone therapy. <h3>Measurements and Main Results</h3> Successful completion of surgery, no complications, the patient reported improvement in her symptoms. <h3>Conclusion</h3> When dealing with severe adhesive disease, abnormal anatomy, and limited space due to a pelvic mass it is key to approach these cases in a stepwise fashion. Visualization can be optimized via temporary measures such as using a Keith needle. If irregular anatomy is noted, landmarks can be identified via the retroperitoneal dissection.

Minimally Invasive Management of a Second Trimester Miscarriage in a Patient with a Non-Communicating Uterine Horn

<h3>Study Objective</h3> We present a rare case of an 18-week missed abortion in a patient with a previously undiagnosed non-communicating uterine horn. <h3>Design</h3> N/A. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> A patient with a history of suspected bicornuate uterus presented with missed abortion at 18 weeks gestation. <h3>Interventions</h3> Prior attempt at dilation and evacuation was unsuccessful and a diagnostic hysteroscopy confirmed no connection between the uterine cavity and the pregnancy. MRI imaging confirmed a unicornuate uterus with a non-communicating horn. Exploratory laparoscopy with hemi-hysterectomy and removal of uterine horn with fetus was performed. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Timely diagnosis of pregnancy within an unruptured non-communicating horn is exceedingly rare. With adequate workup including proper imaging, surgical planning, and technical expertise, safe laparoscopic removal of both the rudimentary horn and fetus is possible and should be offered to spare the patient the morbidity of laparotomy.

8849 Niamh Joyce MD, OBSTETRICS AND GYNECOLOGY, MRCOG, Fellow in Reproductive Medicine

<h3>Study Objective</h3> Video demonstration of fertility sparing laparoscopic treatment for a symptomatic Müllerian Tract abnormality <h3>Design</h3> Single Case Report. <h3>Setting</h3> Tertiary Academic Hospital. 3 port laparoscopy, with patient in Trendelenburg Lithotomy position <h3>Patients or Participants</h3> A 16-year-old nulliparous patient presented with intractable dysmenorrhea since menarche aged 15, associated with syncope. There was no response to analgesia or hormonal contraception and the impact on quality-of-life necessitated surgical review. Initial assessment by pelvic ultrasound identified normal ovaries and uterus but a solid appearing right adnexal lesion. Further imaging by MRI showed evidence of a double uterus with only the left sided uterus communicating with the vagina in keeping with an ASRM class II(b) abnormality. Differential diagnosis included Mullerian duct abnormality and accessory and cavitated mass. A uterine didelphys with only a left ostia was seen on hysteroscopy. Laparoscopy showed a uterine didelphys with a non-communicating, engorged right uterus and right fallopian tube. Her case was discussed at a multidisciplinary meeting where it was decided the most suitable treatment was to perform a laparoscopic hemi-hysterectomy with right salpingectomy to remove the right sided non communicating cavity and tube. This procedure was recorded with the patient's consent and will be shown as part of the video presentation. <h3>Interventions</h3> Laparoscopic hemi-hysterectomy for resection of non-communicating uterine horn. EBL minimal. Operative time 37 Mins, hospital stay 1 night. <h3>Measurements and Main Results</h3> A successful laparoscopic intervention was performed, and the patient was discharged day 1 post op. Review at clinic revealed completed resolution of symptoms, normal menses. Future fertility was a primary concern and was successfully conserved. Histology demonstrated a functioning endometrial cavity with focal adenomyosis. <h3>Conclusion</h3> Class II Müllerian abnormalities are uncommon, affecting around 0.06% of females. Symptoms can include pain or menstrual dysfunction as well as fertility/obstetric complications. When necessary, a minimally invasive approach can be utilized to treat these conditions.

8972 Laparoscopic Rudimentary Horn Removal

<h3>Study Objective</h3> To demonstrate key steps to laparoscopic resection of a rudimentary horn. <h3>Design</h3> A case report. <h3>Setting</h3> A tertiary care teaching hospital. <h3>Patients or Participants</h3> The case is based on a 14-year-old, gravida zero, with a non-communicating rudimentary horn and unicornuate uterus. <h3>Interventions</h3> The video demonstrates pre-operative imaging, highlights key anatomy, and teaches techniques to laparoscopic resection of the horn with oversewing of the defect. <h3>Measurements and Main Results</h3> Safe and efficient laparoscopic non-communicating uterine horn removal. <h3>Conclusion</h3> Laparoscopic uterine horn removal can be a safe and efficient outpatient procedure.

The 13 -year-old-girl with unicornuate uterus with non-communicating uterine horn

The 13 -year-old-girl with unicornuate uterus with non-communicating uterine horn

012 Dysmenorrhea

“Dysmenorrhea”, of which the literal meaning from Ancient Greek, is “difficult menstrual flow”, is characterized by 24–48 h lasting lower abdominal cramps requiring medication or limiting normal activities, starting with menses or within few hours before or after their onset, correlated with ovulatory cycles and with duration and amount of menstrual flow. Nausea, vomiting, headache, dizziness, fatigue and other associated symptoms are often present. By definition, primary dysmenorrhea (PD) occurs with no pelvic pathology affecting 90% adolescents with dysmenorrhea. Secondary dysmenorrhea (SD) is associated with pelvic diseases, is present in 10% cases, being caused mostly by endometriosis and obstructive genital anomalies but also by PID, STDs, early pregnancy complications, adenomyosis, pelvic adhesions, cervical stenosis and other clinical pictures. Typically, PD arises 2 – 3 years after menarche, with onset of ovulatory cycles and may be diagnosed by meaningful history, focused on menstruation, and negative physical exam. Laboratory testing, imaging (US and MRI), hysteroscopy, laparoscopy are needed when SD is suspected. Several treatments exist. Non-medicinal approach includes exercise, acupuncture, topic heat, herbal preparations, magnetic devices, with some effectiveness but further studies are needed. Complementary and alternative medicine (Vitamins, Magnesium, fish oil, Chinese food) may be useful but need stronger evidence. NSAIDs, administered from the onset of bleeding at proper dosage for no longer than 2 – 3 days are first line treatment. Combined EPs, with different preparations and ways of administration, are suggested in sexually active girls and if NSAIDs are ineffective. Levonorgestrel Intra Uterine System (LNG IUS) lowers menstrual pain, now being advisable also in teens. Subdermal Etonorgestrel implant is effective too. In teens Depot medoxyprogesteronacetate rises concerns about bone mass. Because of bone demineralization, GnRH analogues are not allowed in under 16; in later ages an add-back estrogen and progesterone treatment is suggested. If medical treatments fail, laparoscopy is mandatory and not to be postponed: to diagnose and treat endometriosis and to remove functioning non-communicating uterine horns. Obstructive septa of genital anomalies must be removed. Careful follow-up recommended.

Laparoscopic Resection of a Non-Communicating, Functional Uterine Horn

<h3>Study Objective</h3> To demonstrate a case of the surgical correction of a unicornuate uterus with a functional non-communicating horn connected by a thick, fibrous band <h3>Design</h3> A brief literature review and case report with demonstration of surgical technique <h3>Setting</h3> Operating Room environment <h3>Patients or Participants</h3> In this video, we explore a case of a post-menarchal 14-year-old patient who presents with severe dysmenorrhea. Imaging findings were consistent with a functional non-communicating uterine horn. <h3>Interventions</h3> Despite medical suppression, the patient required surgery for intractable pain. Indications for surgical management and preoperative considerations are outlined. The necessary preoperative imaging helped to prepare for surgical excision of the non-communicating uterine horn. <h3>Measurements and Main Results</h3> The ideal surgery includes 10 key surgical steps, including proper dissection of the retroperitoneum, use of blood-conserving strategies and delineation of the connecting band. Assessment for and treatment of any endometriosis can ensure optimal symptom management. <h3>Conclusion</h3> By identifying these patients early with appropriate imaging and through meticulous surgical planning, laparoscopic treatment is both possible and restorative.

Laparoscopic Excision of an Ectopic Pregnancy in a Non-Communicating Uterine Horn

Study Objective Describe an approach to a laparoscopic excision of a uterine horn ectopic pregnancy. Design N/A. Setting The patient was positioned in dorsal lithotomy in stirrups. Four ports were placed including an infra-umbilical port, a supra-pubic port, and two right or left lower quadrant ports 10mm from the midline above the level of the anterior superior iliac spine. Patients or Participants N/A. Interventions The right round ligament was coagulated and cut. The vesicouterine peritoneum was incised and the perivesical space was opened. The right fallopian tube was coagulated along the mesosalpinx. The right uterine artery and vein were isolated laterally and traced to the right horn pregnancy as well as to the left unicornuate uterus. A purse-string suture was performed using a running unidirectional barbed suture to isolate the vasculature pedicle feeding the horn pregnancy. The horn was separated from the uterus using the Harmonic Ace. The resulting pedicle was oversewed with barbed suture. Measurements and Main Results N/A. Conclusion Use of a purse string suture can be considered to minimize blood loss and spare the uterine vasculature at the time of uterine horn ectopic excision. Describe an approach to a laparoscopic excision of a uterine horn ectopic pregnancy. N/A. The patient was positioned in dorsal lithotomy in stirrups. Four ports were placed including an infra-umbilical port, a supra-pubic port, and two right or left lower quadrant ports 10mm from the midline above the level of the anterior superior iliac spine. N/A. The right round ligament was coagulated and cut. The vesicouterine peritoneum was incised and the perivesical space was opened. The right fallopian tube was coagulated along the mesosalpinx. The right uterine artery and vein were isolated laterally and traced to the right horn pregnancy as well as to the left unicornuate uterus. A purse-string suture was performed using a running unidirectional barbed suture to isolate the vasculature pedicle feeding the horn pregnancy. The horn was separated from the uterus using the Harmonic Ace. The resulting pedicle was oversewed with barbed suture. N/A. Use of a purse string suture can be considered to minimize blood loss and spare the uterine vasculature at the time of uterine horn ectopic excision.

Surgical Approach to a Non-Communicating Uterine Horn

<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.

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.

Imaging Manifestations of Accessory Cavitated Uterine Mass-A Rare Mullerian Anomaly.

Context Accessory cavitated uterine mass (ACUM) is an uncommon and under-recognized entity with distinct imaging characteristics and causing significant patient distress. Differentiating it from its other clinical and radiological differentials is therefore extremely important and prevents delay in surgical management which is the treatment of choice. Aims The aim of the study is to describe the MRI appearance of the surgically and pathologically proven ACUM cases from our institution in the last 2 years. Settings and Design This is a retrospective study in a tertiary care hospital in South India. Methods and Material We reviewed the clinical presentations and imaging findings of seven surgically proven cases of ACUM qualifying the proposed diagnostic criteria. Results All patients presented with chronic pelvic pain, dysmenorrhea, and prolonged post-menstrual pain. MRI in all seven cases showed an intramural, noncommunicating, and cavitating lesion near the uterine cornua with internal contents similar to that of endometrioma. Although the cavity was lined by endometrium in all the cases (proven in pathology), it was well appreciable on MRI in only five cases. The rest of the uterine myometrium and main endometrial cavity were normal with no features of adenomyosis. Conclusion MRI is a reliable diagnostic tool for accurate diagnosis of ACUM, and more importantly, in distinguishing it from other causes of chronic pelvic pain like adenomyosis and endometriosis and other imaging differentials like adenomyoma, noncommunicating uterine horn, and degenerating leiomyoma.

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 Excision of a Noncommunicating Uterine Horn Pregnancy

Study Objective To describe the diagnostic challenge and surgical management of a noncommunicating uterine horn pregnancy. Design Clinical history, brief literature review, and video documentation. Setting Patient was placed in dorsal lithotomy for laparoscopic resection of a uterine horn pregnancy in a tertiary care center. Patients or Participants The patient was a 29 year old G1P0 female presenting with a live 11-week extrauterine pregnancy. Radiologic work-up with both pelvic ultrasound and MRI could not fully ascertain diagnosis. Differential diagnosis included tubal ectopic, horn pregnancy of a bicornuate uterus, interstitial pregnancy, and broad ligament pregnancy. Given this was a wanted pregnancy, intra-sac potassium chloride was not administered pre-operatively and the patient was consented for a diagnostic laparoscopy and possible removal of ectopic pregnancy. Interventions Laparoscopy Measurements and Main Results Diagnostic laparoscopy was undertaken where pelvic inspection revealed a right-sided normal appearing unicornuate uterus and a large left rudimentary noncommunicating horn distended by the pregnancy. The pregnancy was connected to the unicornuate uterus via a thick fibrous band. This confirmed a pregnancy in a Type II-B Mullerian anomaly as per the ASRM classification system. Such pregnancies are rare ranging from 1 in 75,000-150,000. Our video demonstrates a stepwise approach for the excision of such pregnancies including isolation of the ureter retroperitoneally, bladder dissection, use of peritoneal landmarks to ensure safe transection of the fibrous band, and use of hemostatic techniques such as vasopressin and advanced bipolar devices. In addition, we demonstrate a simple technique for oophoropexy where we stabilize a hypermobile ovary to the round ligament pedicle using a laparoscopic ligature device. Conclusion Rudimentary horn pregnancies are rare and pose a diagnostic challenge. Complications are common with >50% of such pregnancies presenting ruptured, thus resection is often recommended. We demonstrate that laparoscopy is a safe and feasible option to manage such pregnancies.

Laparoscopic metroplasty: reconstructive surgery for unicornuate uterus with noncommunicating, functional uterine horn

To demonstrate laparoscopic surgery for a patient with unicornuate uterus and a large hematometra in the noncommunicating uterine horn. Narrated video featuring the diagnostic tests and surgical management. Academic tertiary hospital. A 13-year-old woman, gravida 0 with menarche at 9 years old, had severe dysmenorrhea during her recent menstrual cycles. The results of transrectal three-dimensional sonography, hysteroscopy, and magnetic resonance imaging (MRI) were consistent for a uterine didelphys composed of a right unicornuate uterus and a left hemiuterus with hematometra and no connection to the cervix. Left adnexal endometrioma and ipsilateral renal agenesis were also noted. Laparoscopic adhesiolysis and enucleation of the left ovarian endometrioma were first performed. Then, implementing the concepts of Strassman unification method, a horizontal incision was made on the medial side of each hemicorpus, starting from the left rudimentary horn and ending at the fundal area of the right hemiuterus. The incision was carried deep enough to reach the endometrium. The opposing, reverted myometrium was then reapproximated from the lower end of the uterus to the upper fundal part in two layers, using absorbable bidirectional monofilament barbed suture. The outer serosal layer was closed with 1-0 Monocryl via a running continuous suture. On postoperative day 2, the patient was discharged uneventfully. Symptomatic relief and restoration of normal and functional anatomy. The patient has regular menstrual cycles with no recurrence of dysmenorrhea or ovarian endometrioma. At a 2-year postoperative follow-up evaluation, hysteroscopic examination revealed a single uterine cavity with a small fundal septum. The MRI scans showed an anteverted, symmetrical uterus. In comparison with the widely applied hemihysterectomy, reconstructive laparoscopic metroplasty not only effectively achieves symptomatic relief but also offers better uterine symmetry and a larger intrauterine cavity via unification of the uterus.

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.