Non-communicating Rudimentary Horn Research Articles

Ectopic Pregnancy in a Non-communicating Rudimentary Uterine Horn: A Case of Successful Medical Management and Literature Review

Ectopic Pregnancy in a Non-communicating Rudimentary Uterine Horn: A Case of Successful Medical Management and Literature Review

Laparoscopic endoloop excision of non-communicating rudimentary uterine horn ectopic pregnancy in the first trimester

Laparoscopic endoloop excision of non-communicating rudimentary uterine horn ectopic pregnancy in the first trimester

A misleading case of Müllerian anomaly: fibroid degeneration and growth involving nonfunctional, noncommunicating rudimentary horn

ObjectiveTo report a rare, misleading fibroid degeneration involving a non-functional, non-communicating horn in a woman with a unicornuate uterus. While the presence of a functional rudimentary horn may lead to signs and symptoms that recommend its removal, non-functional cases are rarely reported, and due to their apparent functional inactivity, the need for their removal has never been reported. No previous report showed the possibility of a degenerative process in a non-functional rudimentary horn causing patient discomfort. DesignThis is a step-by-step narrated video showing a unique case of fibroid degeneration and growth of a non-functional, non-communicating rudimentary horn in a unicornuate uterus (ASRM classification 2021) and its surgical management. SettingUniversity Academic Hospital ‘‘A.O.U. delle Marche – Università Politecnica delle Marche” Ancona, Italy. SubjectA 48-year-old Caucasian nulliparous premenopausal woman was referred to our institution because of abdominal pain and an enlarging adnexal mass. Her personal history showed primary infertility with a previous diagnosis of unicornuate uterus. Given the possibility of ectopic ureters in these occurrences, a complete computed tomography scan was performed, and no genitourinary alterations were found. Pre-operative imaging (ultrasound evaluation, computed tomography, and magnetic resonance) provided a provisional diagnosis of a suspicious ovarian fibroma. InterventionsConsidering the patient’s age, lack of desire for pregnancy, and volumetric increase of the adnexal mass, a laparoscopic intervention to perform mass removal and prophylactic bilateral salpingectomy was planned. The patient was counseled about the low risk of an underlying malignant transformation. Therefore, the decision to remove the intact mass via a mini-laparotomy at the end of the surgery was shared.Once the abdominal cavity was entered, the right unicornuate uterus was found in anatomical continuity with the ipsilateral broad ligament, fallopian tube, and ovary. These structures were wholly attached to the right pelvic wall.On the other side, cranially compared to the right hemi-uterus, a roundish myoma-like mass was detected in direct connection with the left broad ligament, fallopian tube, and ovary.In light of a changed intraoperative finding, the amputation of the left rudimentary horn and prophylactic bilateral salpingectomy were performed. Main outcome measuresShowing the fibroid degeneration and growth of a non-functional, non-communicating rudimentary horn in a unicornuate uterus (ASRM classification 2021) treated laparoscopically. ResultsLaparoscopic removal of the uterine horn was successful, and no intra- and postoperative complications occurred. The patient was in good health at the six-month follow-up visit. The histopathological examination confirmed the fibroid degeneration and the absence of endometrium. ConclusionThe lack of symptomatic cases of rudimentary non-functional horns reported in the literature led gynecologists to consider them a silent Mullerian anomaly. This unique case demonstrates that even non-functional rudimentary horns can undergo symptomatic transformation processes requiring surgery. This information may be helpful for more comprehensive counseling of women and for considering the possibility of this occurrence in the diagnostic work-up of misleading Müllerian anomalies. With this in mind, surgical treatment can also be better planned as the technical aspects change compared to what is expected for an adnexal pathology.

Pregnancy in Non-communicating Rudimentary Horn

Pregnancy in Non-communicating Rudimentary Horn

Successful pregnancy outcome via in-vitro fertilization and laparoscopic resection of non-communicating rudimentary horn pregnancy containing early pregnancy: a case report

BackgroundNon-communicating rudimentary horn pregnancy (NCRHP) lead to life-threatening condition for both mother and fetus. Early diagnosis of NCRHP and laparoscopic resection is important to prevent catastrophic conditions. However, delayed diagnosis until the second or third trimester makes it difficult to accurately diagnose between NCRHP and bicornuate uterine pregnancy, as both conditions present uterine rupture and massive hemoperitoneum. Furthermore, these rare cases are challenging in pregnancy trials and associated with adverse outcomes in subsequent pregnancies.Case presentationA 31-year-old gravida 1 para 0 Korean woman visited our infertility center with a confirmed positive urine pregnancy test after timed intercourse. Before she was scheduled to have timed intercourse, a unicornuate uterus with a non-communicating right uterine horn was suspected based on an ultrasound scan and hysterosalpingography during the initial infertility workup. A gestational sac was observed in the right non-communicating rudimentary horn at 5 weeks of gestation. Serum beta-human chorionic gonadotropin (b-hCG) level was 2052.0mIU/mL. An elective laparoscopic resection of the right rudimentary horn containing a gestational sac, along with ipsilateral salpingectomy, was performed with no adverse event. After 3-month of recovery period and three cycles of conceptional trials involving timed intercourse and intrauterine insemination, in-vitro fertilization (IVF) was performed using the antagonist protocol, and successful pregnancy was confirmed. The patient had been hospitalized from 21 + 6 weeks to 35 + 6 weeks of gestation, underwent cerclage placement and tocolytics with corticosteroid treatment. She delivered an early-term male baby by cesarean section.ConclusionIn this rare case, the successful pregnancy achieved through IVF following the appropriate management of NCRHP under laparoscopy underscores the critical importance of early diagnosis and intervention in cases of NCRHP. Timely identification and management of NCRHP are vital to prevent the occurrence of catastrophic conditions and to enhance the prognosis of a successful pregnancy through assisted reproductive technology (ART). Therefore, a high index of suspicion for NCRHP is important and employs a range of diagnostic modalities.

A case of noncommunicating rudimentary uterine horn with dysmenorrheal symptoms after cesarean section

A case of noncommunicating rudimentary uterine horn with dysmenorrheal symptoms after cesarean section

Mullerian Duct Anomaly: Two Patients in Adolescent Age in C. R. Gardi Hospital

Clinical manifestations of Mullerian duct abnormalities vary greatly and can range from isolated abnormalities of a single reproductive organ to multiorgan aplasia. An early and precise diagnosis is essential because untreated symptoms may result in pelvic endometriosis, retrograde tubal reflux, and infertility. MRI and ultrasonography are the imaging modality that accurately helps in the diagnosis of mullerian duct anomalies. Two interesting cases came to C. R. Gardi OPD with Mullerian duct anomalies. The first case came with dysmenorrhea and a lower abdominal palpable mass upto 14 wk size was present, which was diagnosed to be bicornuate uterus, obstructed hemivagina. It is a diagnostic dilemma because menses were regular. Another case came with severe cyclic dysmenorrhea and was found to be a hematometra in the non-communicating rudimentary horn on the left side.

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.

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.

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

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

Resection of noncommunicating rudimentary horn

Resection of noncommunicating rudimentary horn

Unresolving cyclic pelvic pain in young women due to rare structural uterine anomalies: a case series

BackgroundThere are many causes for cyclic pelvic pain unresponsive to anti-spasmodic medications in young women. An uncommon, although significant, association in patients presenting with such symptoms is structural uterine anomalies with rudimentary functional cavities. Ultrasound is the first-line modality for the investigation of dysmenorrhea, and the radiologist may be the first person to identify such an underlying condition in the patient. However, transabdominal ultrasound may provide only limited information. Magnetic resonance imaging (MRI) is the imaging modality of choice in such situations due to its high soft tissue resolution and multiplanar capability. This case series is unique in that it primarily highlights the MR imaging of rare structural uterine anomalies in three young females suffering from severe dysmenorrhea, along with an imaging approach.Case presentationWe present three cases of unresolving cyclic pain in young nulliparous females who were radiologically diagnosed with three rare uterine structural anomalies—accessory and cavitated uterine mass, Mayer–Rokitansky–Küster–Hauser syndrome, and functional non-communicating rudimentary horn in a hemiuterus or unicornuate uterus, which were treated with resection leading to symptom relief.ConclusionIn young women with recurrent cyclic pelvic pain, uterine structural abnormalities with functioning cavities should be considered as an etiology and evaluated with MRI. Owing to the non-specific nature of causes of dysmenorrhea, a schematic approach to imaging is essential for identifying the various underlying gynecological conditions, thus aiding in the prompt management of the patient.

Rudimentary horn

A unicornuate uterus with a noncommunicating rudimentary horn is a rare uterine anomaly. The usual presentation is often asymptomatic; however, it can have catastrophic sequelae and long-term morbidity if not diagnosed. A case series of three cases with a varied clinical presentation of noncommunicating rudimentary horn was discussed. All cases had undergone a primary surgery, wherein the rudimentary horn was either unattended or undiagnosed, and later, they had to suffer with long-term morbidities due to complications related to noncommunicating rudimentary horn and had to undergo repeat surgery for definitive management. It should be routine for a surgeon to look for normal anatomy of the uterus and position of the uterine appendages, insertion of round ligaments in any pelvic surgery, and common operations like cesarean sections.

7458 Approach to the Fertility-Preserving Surgical Management of a Unicornuate Uterus with a Noncommunicating, Functional Rudimentary Horn

<h3>Study Objective</h3> To demonstrate how a unicornuate uterus with a functional non-communicating rudimentary horn in a patient desiring fertility can be safely managed with a robotic approach <h3>Design</h3> Stepwise demonstration of the technique with narrated video footage. <h3>Setting</h3> A tertiary academic hospital <h3>Patients or Participants</h3> A healthy 22-year-old presenting with complaints of cyclic dysmenorrhea and desire for future fertility. <h3>Interventions</h3> A robotic-assisted laparoscopic approach to the resection of a functional non-communicating rudimentary horn with several key strategies to minimize blood loss, damage of normal tissue, and prevention of adhesion formation. 1. Placing a stay suture through the tissue of the rudimentary horn to aid with traction and counter traction necessary for enucleation of the horn in the correct tissue cleavage plane. 2. Minimizing blood loss by dilute vasopressin injection at planned incision site along with care to stay within the fibrotic tissue layer connecting the rudimentary horn to the unicornuate uterus. 3. Removing canalized fallopian tube attached to rudimentary horn to prevent rudimentary horn pregnancy. 4. Combination cold dissection with careful and deliberate use of electrosurgery following principles to minimize thermal injury to surrounding normal myometrium. 5. Two-layer non-locking suture to restore tissue integrity, ensure hemostasis, and prevent adhesion formation. 6. Surgical treatment (excision preferred) of all endometriosis at the time of surgery. <h3>Measurements and Main Results</h3> Final pathology confirmed a rudimentary horn with functioning endometrial tissue, endometriosis implants, and endometriosis of the appendix. <h3>Conclusion</h3> This technique allows for the surgical removal of a non-communicating rudimentary horn with: Restoration of anatomy, prevention of rudimentary horn pregnancy, removal of endometriosis, and optimization of future fertility.

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.

Laparoscopic Hemi-Hysterectomy for Excision of a Functional Rudimentary Uterine Horn Keys to Success

<h3>Study Objective</h3> To present a case of unicornuate uterus with a non-communicating rudimentary horn complicated with hematometra and describe important steps for successful laparoscopic surgical management. <h3>Design</h3> Description of the relevant anatomy and surgical technique with the use of video. <h3>Setting</h3> academic tertiary hospital. <h3>Patients or Participants</h3> A 19-yo female patient with history of dysmenorrhea. Exam revealed normal vagina and cervix deviated to the left, with an adnexal mass on the right. Ultrasound and MRI further delineated a right rudimentary horn with active endometrium, possible hematometra. A renal ultrasound ruled out renal anomaly. Hysteroscopy revealed a normal appearing unicornuate uterus with a tubal ostium. A Rummi manipulatorwas placed. Then, laparoscopic pelvic survey confirmed a left unicornuate uterus with an enlarged right rudimentary horn, no endometriosis was found. Next, ureterolysis was performed, followed by right salpingectomy with ovarian preservation. Vasopressin was injected to the base of the horn (20 units in 100 ml of normal saline). The right utero-ovarian and round ligament were taken down with ligasure device and bladder flap was developed. Next, monopolar L hook was used to resect the rudimentary horn. This was followed by uterine closure in two layers with 2-0 V lock barbed suture. Rudimentary horn was exteriorized in a 10 cm endobag. <h3>Interventions</h3> surgical procedure: diagnostic hysteroscopy, laparoscopic hemihysterectomy for excision of a functional non communicating rudimentary horn. <h3>Measurements and Main Results</h3> Patient was discharged on the same day of the procedure and had an uncomplicated postsurgical course. <h3>Conclusion</h3> Understanding the nature of the uterine anomaly before surgery is of paramount importance for the management of obstructive anomalies of the female genital tract. Laparoscopy is a safe and effective treatment modality to provide pain relief, avoid sequelae, and allow for the preservation of reproductive function.

Розрив рудиментарного рогу матки під час вагітності: опис клінічного випадку

в статті описано клінічний випадок розриву рудиментарного рогу матки під час вагітності. Труднощі своєчасної діагностики вагітності в рудиментарному розі матки можуть обумовлювати ургентне оперативне втручання з приводу розриву рогу матки та антенатальної загибелі плода, збільшення частоти акушерських кровотеч, геморагічного шоку та збільшення частоти гемотрансфузій. Метою даного дослідження було продемонструвати варіант розвитку повторної вагітності при однорогій матці з контралатеральним рудиментарним рогом. Матеріалами дослідження слугували дані медичної карти стаціонарної хворої, що включали анамнестичні дані, результати лабораторних та інструментальних досліджень, протокол операцій та епікриз. Вагітна в терміні 16 тижні поступила до приймального відділення міського пологового будинку у 2020 році у вкрай важкому стані з ознаками гострої внутрішньочеревної кровотечі. Враховуючи тяжкий стан пацієнтки, була виконана ургентна нижньосерединна лапаротомія з ревізією черевної порожнини. Під час операції була виявлена аномалія розвитку матки - однорога матка з контралатеральним рудиментарним рогом, не з’єднаним з порожниною матки та з ознаками перерваної вагітності внаслідок розриву рогу. Тактика оперативного лікування включала відсічення рудиментарного рогу, повний гемостаз, санацією та дренування черевної порожнини. Паралельно проводилась інтенсивна терапія: трансфузія свіжозамороженої плазми та еритроцитарної маси. Аналіз літературних джерел щодо питань вроджених аномалій матки показав наявність високого ризику розвитку вагітності саме у рудиментарному розі матки та велику частоту ускладнень даної вагітності у вигляді розриву рогу переважно в ІІ триместрі. Систематизація підходів до вирішення проблеми розриву рудиментарного рогу під час вагітності свідчить про надання вищого пріоритету тактиці збереження нормально розвиненого рогу з паралельною інфузійною терапією у веденні пацієнток з розривом рудиментарного рогу матки та відносно нестабільною гемодинамікою. Разом з тим демонструється обговорення успішних випадків планового видалення рудиментарного рогу з плодом та нормальної повторної вагітності за своєчасного виявлення вродженої аномалії матки. Результати опису даного клінічного випадку можуть бути корисними для акушер-гінекологів, загальних хірургів та лікарів ультразвукової діагностики для удосконалення виявлення рідкісних аномалій розвитку жіночої репродуктивної системи в контексті диференційної діагностики причин "гострого живота" у жінок та оптимізації хірургічної тактики лікування ускладнень вагітності у рудиментарному розі матки.

Factors associated with caesarean section in women referred for preinduction - a nested case-control study in dinoprostone and misoprostol groups.

Induction of labour is a beneficial perinatal procedure, but may be associated with some risks. The aim of this study was to identify factors associated with the need for Caesarean section in women referred for preinduction with dinoprostone and misoprostol. It was a retrospective cohort study of 560 pregnant women who underwent labour induction for medical reasons. Analyses were performed separately in the dinoprostone and misoprostol group. Above other characteristics, the diameters of the pelvis and abdominal circumference of pregnant women were analysed. There were some mothers' characteristics like age, weight, BMI, presence of hypothyroidism or diabetes, which were not associated with Caesarean section deliveries. Women in the misoprostol group with gestational age less than 38 weeks had an increased risk of Caesarean section (OR 2.189; p = 0.041). The analyses of combined effect of mothers age and parity history showed 6.7 (in dinoprostone group) and over 10 times (in misoprostol group) increased the risk of Caesarean section in nulliparous women over 35 years of age. The increased risk of Caesarean delivery in the dinoprostone group was combined with the intertrochanteric dimensions such as the mother's height measuring less than 165 cm, nulliparity and hypertension. In the misoprostol group, strong risk factors for Caesarean delivery were mothers aged 35 years or more, gestational age less than 38 weeks and nulliparity and hypertension as in dinoprostone group. The oxytocin infusion had increased the risk of Caesarean section only in the combined dinoprostone and misoprostol group. Further high-quality studies are warranted.

Non-communicating rudimentary horn pregnancy presenting as sudden unexpected maternal death: an autopsy diagnosis.

Pregnancy on a rudimentary uterine horn is a rare condition that can lead to a catastrophic outcome when it ruptures. The majority of cases are diagnosed late, after the rupture has occurred. We present the case of a 29-year-old female G2 P1 who complained of abdominal pain. She consulted a medical practitioner who prescribed her analgesics. In the next day, she was found dead in her bedroom. The pregnancy was undiagnosed as she was not aware that she was in a gravid state. At autopsy, there was massive haemoperitoneum and a 24-week gestation foetus lying outside the uterus. The uterus revealed an anomaly in keeping with a non- communicating rudimentary horn. Forensic pathologists do encounter undiagnosed ectopic pregnancies in practice. However, abdominal ectopic pregnancy with a uterine anomaly remains uncommon. These cases are often associated with a high maternal and foetal mortality.

Pregnancy Outcomes in Women with Unicornuate Uterus with Non-Communicating Rudimentary Horn

Abstract Objective: The unicornuate uterus is a rare uterine malformation which may results in complications like ectopic pregnancy, infertility, miscarriages, preterm delivery, malpresentations, intrauterine fetal demise. Case Reports: We hereby discuss five cases of unicornuate uterus with non-communicating rudimentary horn and their pregnancy outcomes in tertiary care centre over span of 2 years. All the five cases came at different gestation.Two patients were out-registered and came at term for delivery and unicornuate uterus was diagnosed intraoperatively. Other three cases were registered and had successful pregnancy outcome after proper antenatal care and monitoring. Conclusion: Though unicornuate uterus is linked with adverse pregnancy outcomes. In all these five cases we describe how proper antenatal care and monitoring has resulted