Rudimentary Horn Research Articles

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

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

Rudimentary uterine horn pregnancy in 15 cases: case series with a two-year follow-up

Purpose: The aim of this study was to understand and investigate the reproductive outcomes of patients with rudimentary horn pregnancies after surgical removal of the rudimentary horn. Materials and Methods: The clinical records, including age, obstetric history, gestational age (weeks), presenting feature, preoperative diagnosis, intraoperative diagnosis, blood loss, and surgical management of women who were diagnosed with pregnancy in the rudimentary horn from 2006 to 2010 were reviewed in this retrospective study. The reproductive outcomes of these women that underwent surgical removal of the rudimentary horn were also recorded during the two-year follow-up period. Results: Fifteen women diagnosed with rudimentary horn pregnancies were included in this study and non-communicating horn was accounted for 87.3% of these cases. The gestation periods of them varied from six to 26 weeks. Rupture of the uterine wall occurred in three cases (20%) and no maternal deaths were observed. Eleven patients underwent laparotomy for rudimentary horn removal and four underwent laparoscopic removal. During the two-year follow-up period, ten out of 15 patients (66.7%) became pregnant and seven of them delivered babies, whereas two asked for medical abortion, and only one had spontaneous abortion during the first trimester. Among the seven women giving live births, three of them were vaginally delivered and four were by cesarean section, five women were term pregnancy, and the other two women gave birth prematurely. Conclusion: This study indicates that the early diagnosis, proper consultation, and quick surgical treatment in patients with rudimentary horn pregnancies are necessary.

Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn

BackgroundHeterotopic pregnancies implanted in a rudimentary uterine horn account for 1 in 2–3 million gestations, and confer significant risk of morbidity due to uterine rupture and hemorrhage.Case presentationA 34-year-old nullipara presented with acute pelvic pain at 17 weeks of gestation with dichorionic-diamniotic twins, one in each horn of an anomalous uterus first diagnosed in pregnancy as bicornuate. Three-dimensional ultrasound and MRI revealed myometrial disruption in the left rudimentary uterine horn, and the patient underwent an uncomplicated abdominal hemi-hysterectomy. Fourteen days later, an uncomplicated dilation and curettage was performed for a fetal anomaly in the remaining twin in the right unicornuate uterus.ConclusionThis case demonstrates the utility of magnetic resonance imaging and three-dimensional ultrasound in the assessment of myometrial integrity in a gravid patient with a heterotopic pregnancy and ruptured rudimentary uterine horn. This case demonstrates the importance of pre-pregnancy diagnosis and management of mullerian anomalies.

Novel Management of Ectopic Pregnancy in a Noncommunicating Rudimentary Horn of a Unicornuate Uterus

Pregnancy in a rudimentary horn is a rarely encountered form of ectopic pregnancy and is often an emergent situation because of the risk of rupture of the horn. A 31-year-old gravida 3 para 1 woman with 7 to 8 weeks' gestational age was found to have a viable pregnancy in a rudimentary noncommunicating horn of a unicornuate uterus. She elected termination of the pregnancy via local intracardiac lidocaine and intra-amniotic methotrexate injections. Subsequent removal of the rudimentary horn was necessary to prevent recurrence. Because of the risk of rupture, the diagnosis and management of an ectopic pregnancy in a rudimentary horn can be emergent.

Rupture of Non-communicating Rudimentary Horn of Unicornuate Uterus with Pregnancy

AbstractUnicornuate uterus with a non-communicating horn is a rare anomaly and even rarer pregnancy in its non-communicating horn. The incidence of pregnancy in the non-communicating horn is 1 in 76,000 to 1 in 150,000. Due to non-compliant uterine musculature in the non-communicating horn, it is prone to rupture in cases of pregnancy. The rupture occurs usually in the second trimester. We describe a case which presented with the rupture of non-communicating horn with live fetus inside it. The present case had a 22 week fetus floating in the peritoneal cavity following the rupture of non-communicating horn with normal other uterine horn.

Four new species of Magelona (Annelida: Magelonidae) fromEaster Island, Guam and Hawaii.

Several collections of magelonids from Easter Island, Guam in the Mariana Islands and Hawaii were examined. Five magelonids are fully described and illustrated: Magelona anuheone sp. nov. (Easter Island), M. cf. symmetrica Mortimer Mackie, 2006 (Guam), M. alexandrae sp. nov. (Hawaii), M. cinthyae sp. nov. (Hawaii) and M. paulolanai sp. nov. (Hawaii and Guam). Magelona anuheone sp. nov. has a distinctly longer than wide prostomium with inflated and well-developed prostomial horns, similar to M. montera from the Indian Ocean. Magelona alexandrae sp. nov. belongs to Magelona species with crenulated upper margin of thoracic postchaetal lamellae and also well-developed prostomial horns. Magelona cinthyae sp. nov. is unique among its congeners in that several collected adult individuals presented two or more eyespots in the prostomium, a feature only previously recorded to pelagic larval stages. Magelona paulolanai sp. nov. belongs to a group of species with rudimentary prostomial horns, simple capillaries on chaetiger 9 and tridentate abdominal hooks. All species are illustrated and compared to their morphologically similar congeners.

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.

A rare case of ruptured bicornuate uterus at Karnali Academy of Health Sciences

Not available.

A Comparative Analysis of Cryptomenorrhea in Patients with Vaginal Obstruction Vis a Vis Patients with Rudimentary non Communicating Horn of Uterus with Functional Endometrium: A Retrospective Study

A Comparative Analysis of Cryptomenorrhea in Patients with Vaginal Obstruction Vis a Vis Patients with Rudimentary non Communicating Horn of Uterus with Functional Endometrium: A Retrospective Study

Ectopic pregnancy în rudimentary horn: early diagnosis and management

Pregnancy in rudimentary horn is a rare clinical entity with an incidence ranging from 1:76.000 to 1:140.000 preg­nan­cies. The symptomatology that accompanies pregnancy de­ve­loped in rudimentary horn is similar to that of ectopic preg­nan­cies or may evolve as a normal pregnancy. It is dif­ficult to diagnose in the first trimester of pregnancy when conservative treatment is possible, with minimal mor­bi­di­ty, frequently evolving until the second trimester when clinically manifests as a uterine rupture syndrome and it is accompanied by intraperitoneal hemorrhage and he­mor­rhagic shock. It is desirable that the diagnosis of these pregnancies to be established as early as possible in the first trimester of pregnancy and they will be terminated as soon as they have been diagnosed with certainty.

Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn

Previous studies have shown adverse obstetric outcomes of the laparoscopic resection of a rudimentary horn. Our study aimed to investigate the obstetric outcome in our institution and to review previous studies. Using a retrospective analysis, data were reviewed from singleton pregnancies with maternal uterine anomalies at a medical center in Osaka, Japan, between January 2011 and March 2016. The uterine anomaly cases were divided into a 'postlaparoscopic resection of the rudimentary horn' group (study group) and an 'other uterine anomalies' (bicornuate uterus, uterine didelphys and unicornuate uterus) group (control group). Primary outcomes of interest were differences in obstetric outcomes, such as spontaneous preterm birth rate, small for gestational age (SGA) infant rate and hypertensive disorders of pregnancy (HDP) rate between the study and the control group, and the secondary outcome of interest was mode of delivery in the study group. Data from 40 deliveries were included in the study (7 deliveries: study group, 33 deliveries: control group). No significant difference was observed between the two groups in terms of either mean gestational weeks at delivery (36.4 weeks vs 37.1 weeks; P = .38), cesarean delivery rate (57.1% vs 57.5%; P = 1.0), SGA infant rate (<10th percentile) (0% vs 24.2%; P = .31) and HDP rate (0.0% vs 3.0%; P = 1.0). Three of seven cases with postlaparoscopic resection of the rudimentary horn were able to deliver vaginally without complications. Our study shows that the obstetric outcome observed in the study group was similar to that observed in the control group.

Ruptured Rudimentary Horn Pregnancy in a Multiparous Patient: A Case Report and Literature Review

We present a case report of 31 yrs old Gravida 4 para 2+1 patient with two previous term vaginal deliveries. She presented with a rupture of undiagnosed rudimentary horn of uterus at 18 weeks. Laparotomy was performed and rudimentary horn was excised with good recovery postoperatively. The need for high index of suspicion and early diagnosis using ultrasonography is emphasised. Conclusion: Pregnancy in a rudimentary horn carries grave risk to the mother. There is need for increase awareness of this rare condition and to have a high index of suspicion at time of booking.

Uterine rupture of a non-communicating rudimentary horn pregnancy with resultant successful outcome of an extremely premature baby born at 24 weeks of gestation

Abstract Mullerian anomalies occur in about 0.5% of reproductive-aged women; many remain asymptomatic only being discovered during surgery or on imaging done for unrelated reasons. These result from the abnormal formation, fusion or resorption of the mullerian duct during development. A unicornuate uterus with a rudimentary horn is one of the rarer subtypes, with such anomalies making up about 5% of all mullerian anomalies. Pregnancy in a non-communicating uterine horn (NCUH) is extremely rare, with an incidence between 1:100,000 and 1:140,000. There is a high risk of uterine rupture if pregnancy occurs in a non-communicating uterine horn. We present here a case of a non-communicating rudimentary horn pregnancy, with a successful outcome.

Pregnancy in the non-communicating rudimentary horn of a unicornuate Uterus: a case report of Saghez

Pregnancy in the non-communicating rudimentary horn of a unicornuate Uterus: a case report of Saghez

Multimodality Study of a Twin Pregnancy Within a Rudimentary Horn

Pregnancies within rudimentary horns of unicornuate uteri are extremely rare. These pregnancies account for approximately 1 in 76 000 to 1 in 140 000 worldwide, with uterine rupture being the most concerning complication. A case is presented of a 24-year-old female, gravida 2, para 0, who underwent multiple sonograms pertaining to two gestations over a 3-year period. Both pregnancies occurred within the left rudimentary horn of a unicornuate uterus. The left rudimentary horn was confirmed, on magnetic resonance imaging, to have no communication with the right horn or endocervical canal. The first pregnancy resulted in a missed abortion, and the second pregnancy, 3 years later, was a twin gestation, which was carefully monitored. At 20 weeks, the uterus began to rupture, and an emergency C-section was attempted. Neither the fetus nor the rudimentary horn survived, which was excised. This case demonstrates a rare uterine finding, a pregnancy occurred twice within the horn that lacked communication with the cervix.

Non-communicating Rudimentary Horn Pregnancy—A Rare Clinical Scenario

Non-communicating Rudimentary Horn Pregnancy—A Rare Clinical Scenario

Preoperative diagnosis and laparoscopic resection of a rudimentary horn pregnancy: A case report

Preoperative diagnosis and laparoscopic resection of a rudimentary horn pregnancy: A case report

Ruptured Ectopic Pregnancy in Rudimentary Horn of Unicornuate Uterus

Ruptured Ectopic Pregnancy in Rudimentary Horn of Unicornuate Uterus

MR imaging evaluation of obstructing vaginal malformations with hematocolpos or hematometra in adolescent girls: A cross sectional study

ObjectiveVaginal or uterine outlet obstruction leads to hematocolpos or hematometra. Detection of the etiology of this entity is important to guide adequate surgical management and thereby avoid complications and to preserve fertility. The aim of this study was to evaluate obstructing vaginal malformations in adolescent girls presenting with hematocolpos or hematometra with MR imaging. Materials and methodsA hospital based prospective study was conducted in a tertiary care centre from September 2015 to October 2016. The study included 17 adolescent females who were evaluated with MRI. ResultOf 17 adolescent female with vaginal or uterine outflow obstructive anomalies with hematocolpos or hematometra, where 6 patients (35.3%) had HWWS, 6 patients (35.3%) had imperforate hymen, 2 patients (11.8%) had transverse vaginal septum, 1 patient each (5.9%) had cervico-vaginal atresia, unicornuate uterus and communicating rudimentary Uterine horn. MRI revealed hematocolpos in 15 patients (88.2%), hematometra in 13 patients (76.5%), endometriotic ovarian cysts in 6 patients (35.3%) and hematosalpnix in 3 patients (17.6%). ConclusionEarly radiological diagnosis of the cause of vaginal or uterine outflow obstruction is important to guide adequate surgical management which if undertaken promptly helps to avoid complications due to reflux from vaginal or uterine outflow obstruction.

Laparoscopic Management of Leiomyoma Arising from Müllerian Remnant in Mayer–Rokitansky–Küster–Hauser Syndrome

Abstract Background: Leiomyomas arising from Mullerian remnants are a rare association with few case reports in literature. Most of the case reports have shown management with laparotomy. This report presents a case of a leiomyoma arising in a Mullerian remnant that was managed with laparoscopy. Case: A 33-year-old nulligravida presented with dyspareunia since marriage and an increase in urinary frequency since 3 years prior to presentation with no history of cyclical abdominal pain. Pelvic examination revealed a vaginal length of 7 cm and a 6 × 6 cm, firm right adnexal mass. Magnetic resonance imaging was suggestive of a hypoplastic uterus with a submucosal myoma or a broad ligament myoma. Laparoscopy showed a bilobed leiomyoma arising from the right Mullerian anlage with the right fallopian tube and ovary attached to its postero-superior surface. The bilobed leiomyoma, and the right Mullerian remnant along with the left rudimentary horn and both tubes were removed as a single contiguous specimen. Result...