Rudimentary Horn Research Articles

Rudimentary Corneal Rupture of A Unicornuate Uterus in A 23-Week Pregnancy: About A Case

The rudimentary uterine horn belongs to the group of major uterine malformations according to the classification of Musset's classification. This rudimentary horn may have a cavity with endometrial lining of the uterus, and thus can serve as a site of implantation during pregnancy. The presence of a pregnancy in a rudimentary horn is a rare event, which can be revealed by a uterine rupture. It leads to an emergency fetal extraction and it is then recommended to perform an exeresis of this rudimentary horn [6, 7]. If it is not performed, it theoretically exposes the risk of recurrence of uterine rupture in case of a new pregnancy in this rudimentary horn. There is a need to increase awareness of this disease, especially in developing countries where the possibility of detection of the disease is limited. We report a case of ruptured rudimentary horn pregnancy in shock at 23 weeks of gestation misdiagnosed as intrauterine pregnancy. The pregnancy was located in a rudimentary left uterine horn ruptured on its posterior surface and communicating with the right horn. A hemi hysterectomy was then performed with the removal of the rudimentary horn and the homolateral adnexa. The fetus was deadborn. The postoperative course was simple and the patient was discharged on the fifth postoperative day.

Uterine rupture of a patient with rudimentary horn pregnancy at 26th gestational weeks.

Introduction and importancePregnancy of Rudimentary Horn is a type of ectopic pregnancy, that is recognized almost always during surgical treatment of a rupture of the rudimentary horn. This is an obstetric case diagnosed preoperatively by magnetic resonance imaging (MRI).Case presentationWe report the case of a 19-years-old primigravida patient with rupture of rudimentary horn in 26th gestational week. The patient presented with sudden onset severe abdominal pain in the emergency room. Intraabdominal free fluid is detected. To evaluate the etiology of free fluid and location of the gestational sac, an abdominal magnetic resonance imaging (MRI) scan was planned. The decision of emergent laparotomy is made because of sonographic detection of abdominal excessive -concentrated- free fluid, abdominal tenderness, and 2 points decrease of hemoglobin value in the control hemogram. A rudimentary horn pregnancy and fundal rupture of the rudimentary part of the uterus are diagnosed during the surgical procedure. A baby -live- weighing 450 g was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed.Clinical discussionRudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Identifying both cornuas systematically in all patients increases the detection rate. The absence of continuity between the gestational sac's lumen and the cervical canal on imaging is an important finding.ConclusionDue to the serious maternal and fetal complications, its detection at an early week may be life-saving.

1 Surgical approach for the non-communicating rudimentary horn of a pregnant unicornuate uterus during c-section

Introduction and aims of the study: Unicornuate uterus with a rudimentary horn is a congenital uterine malformation as a result of fusion defects of the Mullerian ducts and is commonly associated with renal tract anomalies. This pathology relates to poor obstetric outcomes, moreover, since pre- and post-conceptional management of rudimentary horns with functioning endometrium remains indefinite. The aim of this report is to illustrate a different approach to the rudimentary horn at the moment of delivery.

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.

A RARE CASE OF PREGNANCY IN THE RUDIMENTARY UTERINE HORN

BACKGROUND: An unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Mullerian ducts and an incomplete fusion with the banana shaped contralateral side, normally developed horn. In 83% of patients, the rudimentary horn has no direct connection to the endometrial cavity of normal horn. Pregnancy in rudimentary horn is a rare clinical condition with a reported incidence of 1 in 1, 00,000-1, 40,000 pregnancies. It is postulated that the sperm or fertilized ovum migrates transperitoneally from the contralateral tube to the tube connected to rudimentary horn and eventually implanted into the endometrial cavity of that rudimentary horn. Usually the diagnosis may missed and may present as an emergency with hemoperitonium. Therefore this case highlights the importance of early ultrasound in detecting uterine anomalies and need for high clinical suspicion.

A rare case of the new entity of müllerian anomalies mimicking the noncommunicating rudimentary cavity with hemi-uterus: accessory cavitated uterine mass

To demonstrate the laparoscopic excision of an accessory cavitated uterine mass (ACUM) and show that atypical anomalies can lead to the misdiagnosis of a noncommunicating rudimentary horn. Description and step-by-step demonstration of the surgical procedure using a video recording (Canadian Task Force Classification 3). University hospital. A 17-year-old virgin girl with chronic pelvic pain and severe progressive dysmenorrhea despite using nonsteroidal anti-inflammatory drugs and oral contraceptives since her menarche. We could not perform transvaginal examination and ultrasonography because of the virginity of the girl. Transabdominal ultrasound revealed a 24 × 24-mm heterogeneous cystic mass on the left adnexal region suggesting a noncommunicating functional rudimentary horn. This mass was within the left lateral uterine myometrial wall, and otherwise, the uterus and endometrial cavity seemed normal on ultrasonographic examination. Magnetic resonance imaging showed a cavitated nodule of 25 mm with hemorrhagic components inside the mass on the left side of the uterus and the normal endometrial cavity with a normal size uterus. After detailed evaluation and counseling, a decision was taken to perform laparoscopy. Laparoscopic resection of the ACUM. On laparoscopic exploration, we first observed a globular enlargement on the left wall of the uterus under the round ligament. Both the ovaries and the uterus were normal, and there were two normally developed fallopian tubes with no abnormality communicating with the normal uterus. The mass had irregular muscle fibers and ambiguous limits for detaching from the normal myometrial tissue. Afterward, the mass was resected completely without entering the endometrial cavity. It was thought that these irregular borders may be a factor of confusion as a degenerated myoma on the diagnosis. The blunt and sharp dissection methods were used bidirectionally, and finally, the lesion was enucleated. The mass was incised, and chocolate-like brownish fluid spilled out from the cavity of the mass. The endometrium-like epithelium and surrounding muscular layer were seen on the mass. The myometrial defect was approximated and closed with a polyglactin absorbable suture. Histopathological examination revealed the endometrial lining cavitated mass surrounded by myometrium, and thus, it was consistent with the diagnosis of ACUM. The postoperative period of the patient was uneventful. She was discharged without any complaint. Her severe pelvic pain and symptoms of dysmenorrhea were resolved 1 month after the surgery. We did not prescribe any medication for menstrual suppression and pain management before or after surgery. During the follow-up period, she had a regular menstrual cycle and no pelvic pain and dysmenorrhea for 2 years. Accessory cavitated uterine mass is a new entity having a normal endometrial cavity and is different from other müllerian duct anomalies. Severe dysmenorrhea and chronic pelvic pain are early-onset, and they are persistent despite using medications, but suspecting this problem is the main determinant for confirming the diagnosis. The final diagnosis of ACUM can be made after resecting the mass and confirming with histopathological examination. Accessory cavitated uterine mass may be confused with a similar lesion of juvenile cystic adenomyosis (JCA). They present very similar clinical and pathological findings, but JCA is a rare form of focal adenomyosis that contains cystic contents inside the lesion, and it has more intense adenomyosis surrounding the endometrial lining of a cavitated mass. In our case, histopathological examination revealed muscle fibers around the endometrial epithelium, with no adenomyotic foci. It was so difficult to distinguish these two similar lesions during the surgery. Thus, we could distinguish ACUM from JCA with this pathological confirmation. Accessory cavitated uterine mass may also be misdiagnosed as U4a of ESHRE/ESGE classification and 2b of ASRM classification, but it should be distinguished from these anomalies. Moreover, it is important to define ACUM clearly in the U4 or U6 class of the ESHRE/ESGE and 2b of ASRM classification systems.

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review.

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.

Rudimentary Horn Pregnancy- A diagnostic dilemma

Abstract Pregnancy implanted in the rudimentary horn of unicornuate uterus is very rare with an incidence of 1 in 75,000 to 1 in 150,000 pregnancies. Half of them rupture, and 80% of the rupture occurs in first and second trimesters. Atrocious outcomes are reported. Horn pregnancy rarely reaches third trimester and when it does the diagnosis becomes more challenging. Ectopic in unicornuate rudimentary horn of uterus is difficult to diagnose even with best facilities available. Consequences are grave with slightest error of radiological and clinical judgment. Here we present case series of women who had rudimentary horn pregnancy and presented with varied clinical presentation, however they went undiagnosed even after radiological assessment and it lead to exaggerated maternal morbidity. The purpose is to spread awareness of all such rare cases where maternal and fetal wellbeing is jeopardized, and accentuates the significance of high index of suspicion in all such cases

An Ectopic Ovary: A Unicornuate Uterus with a Rudimentary Horn: Is there a Connection?

An Ectopic Ovary: A Unicornuate Uterus with a Rudimentary Horn: Is there a Connection?

Robot-assisted resection of interstitial rudimentary uterine horn in girls

<h3></h3> Интерстициально распложенный рудиментарный рог матки (ИРРРМ) — крайне редко встречающаяся аномалия производных мюллерова протока. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить возможности и особенности проведения робот-ассистированной резекции (РАР) ИРРРМ у девочек-подростков. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проведен анализ историй болезни и особенностей робот-ассистированного оперативного вмешательства, результатов гистологического исследования и катамнеза у девочек 13, 14 и 15 лет с ИРРРМ. <h3>РЕЗУЛЬТАТЫ</h3> Несмотря на выраженность болевого синдрома (по ВАШ — 8,7±1,2 балла), продолжительность заболевания до установления диагноза составила 2,3±1,5 года при менструальном возрасте девочек 3,3±1,2 года. Продолжительность операции 166,7±28,9 мин, доконсольный этап 43,3±5,8 мин. Основные затруднения возникали при идентификации границы между канализированной половиной матки и замкнутой. Хирург ориентировался на визуальные и тактильные ощущения. Установка на сохранение целостности канализированной части в 1 случае привела к тому, что при патоморфологическом исследовании в иссеченной части не выявлена эндометриальная ткань. Объем кровопотери 25,0±21,8 мл (10; 50). Болевой синдром в последующие 6 мес наблюдения отсутствовал у всех пациенток. <h3>ЗАКЛЮЧЕНИЕ</h3> Робот-ассистированная резекция у девочек дает возможность бескровного удаления интерстициально расположенного рудиментарного рога матки, полной ликвидации болевого синдрома после операции. Основное затруднение возникает при идентификации границы между половинами матки.

Role of preoperative imaging in laparoscopic management of unicornuate uterus associated with a noncommunicating rudimentary horn: A report of three cases

Role of preoperative imaging in laparoscopic management of unicornuate uterus associated with a noncommunicating rudimentary horn: A report of three cases

Diagnosis and management of non-communicating rudimentary horn pregnancy.

Non-communicating rudimentary horn pregnancy is a rare condition associated with serious complications and consequences. We reported a case of a 44-day non-communicating rudimentary horn pregnancy who was diagnosed by three-dimensional ultrasound (3D-US) and pelvic magnetic resonance imaging (MRI), followed by treatment via laparoscopic resection. The 3D-US and pelvic MRI scan showed a consistent result. Serious complications and consequences were avoided. Postoperative diagnosis showed that the malformation was classified as type IIc. For such diagnosis as a unicornuate uterus with a rudimentary horn, if there are no symptoms, it cannot be treated. Once pregnancy is in the rudimentary horn, 3D-US or MRI should be conducted to determine the implantation location of the pregnancy capsule and the operation should be performed as soon as possible to avoid uterine rupture. Laparoscopic surgery can be chosen in the early stage.

Embarazo a término en útero bicorne con cuerno rudimentario no comunicante. Reporte de un caso

The bicorne uterus with a rudimentary non-communicating horn may be associated with gynecological and obstetric complications such as infertility, endometriosis, hematometra, urinary tract abnormalities, abortions, and preterm deliveries. Excision of the rudimentary horn should be done outside of pregnancy, with followup during pregnancy, looking for complications. We present the case of a 40-year-old patient, who presented abdominal pain and vaginal bleeding, with a full-term pregnancy in a rudimentary non-communicating horn of a bicorne uterus. Physical examination showed abdominal distention and loss of uterine contour and no fetal parts were palpated. The provisional diagnosis of rupture of the uterus was made. Emergency laparotomy revealed a dead and deformed fetus, 37 weeks old, in a bicorne uterus with a broken rudimentary non-communicating horn, along with an acretic placenta. Extraction of the gestational sac, fetus and placenta and subtotal hysterectomy with conservation of the left annex were performed. Keywords: Rudimentary horn not communicating, Bicornuate uterus, Term pregnancy

Unicornuate Uterus with Rudimentary Horn and Non-Communicating Functional Endometrium: A Case Report

Mullerian anomalies are congenital disorders affecting 1 to 10% of population. Normally during fetal development, two paired mullerian ducts develop into female reproductive tract including fallopian tubes, uterus, cervix and upper two thirds of vagina. When one mullerian duct fails to develop or is under developed, unicornuate uterus is formed. When the contralateral duct undergoes some development, rudimentary horn is formed. 70-85% of patients also present with unilateral renal agenesis. A 15-years-old adolescent female presented with dysmenorrhea since menarche. Abdominal examination revealed an enlarged uterus. Ultrasonography showed unicornuate uterus along with absence of a unilateral kidney. We received a rudimentary horn along with a large hemorrhagic fluid filled uniloculated cyst with another small cyst. On microscopic examination, section studied from rudimentary horn has features of proliferative endometrium. Section studied from cyst wall is lined by cuboidal epithelium. Patients having mullerian duct anomalies usually present with dysmenorrhea and chronic pelvic pain. Unicornuate uterus with rudimentary horn is the least frequent form. We present a congenital anomaly rather rare among the population- unicornuate uterus with rudimentary horn which is a cause for variety of symptoms. Keywords: Unicornuate uterus, Rudimentary horn, Functional endometrium

Pregnancy on a Rudimentary Unbroken Horn of a Pseudo-Unicornuate Uterus: A Case Report at The University Hospital of Angre Abidjan

The pseudo-unicornuate uterus which is a rare uterine malformation, that can be the site of a pregnancy. Pregnancies in the rudimentary horn usually result in a rupture due to a uterine wall not adapted to the level of the horn, but especially diagnostic difficulties. Their discovery is most often made in intraoperative, when an indication of laparotomy is made for hemoperitoneum in emergency. They are therefore responsible for high maternal-fetal mortality and morbidity. We report in this observation a case of pregnancy in a rudimentary unruptured horn, in a 28-year-old, 4th gesture 2nd parous, the discovery of which was made incidentally, during an indication of laparotomy posed for suspected abdominal pregnancy complicated by a surgical abdomen.

Accurate identification and surgical correction of type IIb uterine malformation using synchronized hysteroscopy and laparoscopy

To introduce an effective approach for accurate identification and treatment of type IIb uterine malformation using synchronized hysteroscopy and laparoscopy. Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique. The patient provided written informed consent for video and data collection for research purposes. The study was approved by the local ethics committee of Shengjing Hospital of China Medical University. Academic medical center. A 32-year-old young woman diagnosed with a right unicornuate uterus with a left rudimentary horn, with a 2-year history of dysmenorrhea. First, the patient was diagnosed with a unicornuate uterus with a rudimentary horn using ultrasonography and magnetic resonance imaging before the surgery. During surgery, synchronized hysteroscopy and laparoscopy coupled with a light test was performed to make a definite identification of the type IIb uterine malformation. During treatment of the type IIb uterine malformation, there were two key steps: resected the rudimentary horn and reserved more myometrial tissue to reduce the risk of uterine rupture in a subsequent pregnancy; and corrected the uterus to prevent future uterine prolapse. For the suture technique, suturing during resection was performed instead of suturing after complete resection to reduce the intraoperative bleeding as much as possible. Furthermore, tubal catheterization and hydrotubation under hysteroscopy monitoring were performed. Value and feasibility of synchronized hysteroscopic and laparoscopic identification and treatment of the type IIb uterine malformation. The total operation time was 89 minutes. The postoperative pathological findings revealed that the endometrium was found in the rudimentary horn. No dysmenorrhea was found during follow-up. At 26 months after the operation, the patient became pregnant naturally. Cesarean section was performed at 36 weeks + 2 days owing to premature rupture of the membranes. For the accurate identification and management of a type IIb uterine malformation, synchronized hysteroscopy and laparoscopy is an effective and feasible method.

Robotic-assisted laparoscopic cervicouterine anastomosis in a patient with agenesis of the uterine isthmus

To demonstrate the surgical management of agenesis of the uterine isthmus. Stepwise description of robotic-assisted laparoscopic cervicouterine anastomosis. Academic medical center. A 27-year-old nulligravida with primary amenorrhea and cyclic pelvic pain. The patient underwent a robot-assisted cervicouterine anastomosis using the following surgical steps: adhesiolysis of the right ovary from the rudimentary uterine horn; vesicouterine peritoneal fold dissection and mobilization of the cervical canal; the opening of the cervical canal and dilatation with Hegar dilators; longitudinal incision of the lower third of the anterior uterine wall up to the endometrial cavity; insertion of a 14 Ch Foley catheter, not inflated, fixed to the cervix with a suture and removed after 7 days; and closure of the cervicouterine breach with a double-layer Vicryl suture. Informed consent was obtained from the patient for the use of video and images. After 3 months, the patency of the anastomosis site was assessed via hysteroscopy. Subsequent follow-up was performed by referring physicians. Postoperatively, anatomic continuity was restored and the patient was menstruating with regular monthly cycles; furthermore, cyclic pelvic pain was relieved. Few cases of this condition have been reported in the literature and, currently, surgical treatment of agenesis of the uterine isthmus is controversial, with some treatments including laparoscopic-assisted uterocervical anastomosis using a stent to prevent restenosis, primary cervicouterine anastomosis by laparotomy performed with a Foley catheter in the cervical canal, and anastomosis of the uterine isthmus agenesis. However, to our knowledge, we are the first to use a robotic approach. Preservation of reproductive function and symptom relief represent the goals of the surgery. Therefore, hysterectomy cannot be considered as a treatment option. However, after a cervicouterine anastomosis procedure, the normal uterine morphology cannot be achieved; cyclic abdominal pain may remain after surgical treatment. In this case, an alternative surgical approach, such as hysterectomy, can be considered. Robotic-assisted treatment of this uncommon müllerian anomaly is feasible and may be an alternative to hysterectomy in individuals who wish to preserve fertility. Follow-up is needed to evaluate fertility and reproductive function.

Cornual Pregnancy

A true cornual pregnancy is one in the rudimentary horn of a unicornuate uterus. The term is often used interchangeably in the medical literature with interstitial pregnancy but the 2 are distinct entities [ 1 Chetty M Elson J. Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol. 2009; 23: 529-538 Google Scholar ]. With recent diagnostic advances, early detection is possible [ 2 Afifi Y Mahmud A Fatma A. Hemostatic techniques for laparoscopic management of cornual pregnancy: double-impact devascularization technique. J Minim Invasive Gynecol. 2016; 23: 274-280 Google Scholar ] The ultrasonographic criteria are an empty uterine cavity, a gestational sac located eccentrically and 1 cm from the most lateral wall of the uterine cavity, and a thin (less than 5 mm) myometrial layer surrounding the gestational sac. Treatment of cornual pregnancy has been surgical and may include hysterectomy or cornual resection by laparotomy or laparoscopy. However, increasingly, more conservative approaches are being used such as cornuostomy instead of cornual resection, as well as laparoscopy instead of laparotomy. Although patients with milder symptoms may be considered for medical therapy (methotrexate), those with serious signs and symptoms of ruptured ectopic pregnancy are likely to receive immediate surgical intervention [ 3 Dagar M Srivastava M Ganguli I Bhardwaj P Sharma N Chawla D. Interstitial and cornual ectopic pregnancy: conservative surgical and medical management. J Obstet Gynaecol India. 2018; 68: 471-476 Google Scholar ]. The treatment goal of cornual pregnancy conservative management is to remove the gestational sac without damaging the myometrium, an accident that causes massive bleeding and requires immediate, urgent, laparotomy [ 4 Tinelli R Stomati M Surico D Cicinelli E Trojano G Angioni S. Laparoscopic management of a cornual pregnancy following failed methotrexate treatment: case report and review of literature. Gynecol Endocrinol. 2020; 36: 743-745 Google Scholar , 5 Damiani GR Landi S Tartagni M Bettocchi S Loverro G Pellegrino A. Cornual pregnancy after surgical treatment of an incarcerated fallopian tube: a case report. J Reprod Med. 2013; 58: 550-552 Google Scholar ]. Different authors have reported many types of suture to reduce intraoperative blood loss and gain optimal myometrial reconstruction: •Square suture: carried through the posterior and anterior cornual walls and then carried back through the anterior and posterior wall at a point 2 cm lateral to the initial knot. The knot is tied intracorporeally, achieving hemostasis by compression. •Encircling suture: around the base of the cornual ectopic, acts like a tourniquet •Endoloop device •Electrocoagulation (high risk of damaging myometrium) •Automatic staplers •Endo GIA (Covidien) stapler simultaneously excises and stitches the uterine cornua.

Case Report of a 20-Year Diagnostic Delay; Difficulty in Diagnosing a Uterine Anomaly

This is the case of a 46-year-old woman who first presented to gynaecology clinic aged 26 with severe dysmenorrhoea. She has medical history of left renal agenesis and a previous left oophorectomy. Over the course of 20 years she was extensively imaged with ultrasound (US), magnetic resonance imaging (MRI) and computerised tomography (CT) with the diagnosis of a right unicornuate uterus with an obstructed left rudimentary horn only made recently following 11 scans. There are many factors in this case that confused the picture and made diagnosis more challenging including an incomplete history, language barrier, possibility of a pelvic kidney and changes in imaging of an obstructed horn.

Successful pregnancy and term delivery after treatment of unicornuate uterus with non-communicating rudimentary horn pregnancy with local methotrexate injection followed by laparoscopic resection: a case report and literature review

BackgroundPregnancy in a rudimentary horn is an extremely rare type of ectopic pregnancy. A rudimentary uterine horn pregnancy is associated with a risk of spontaneous rupture and bleeding during surgery due to the increased uterine blood flow. Recent advances in imaging modalities have enabled laparoscopic surgery to be performed in cases without rupture in the early stages of pregnancy. However, there are few reports of successful pregnancies and deliveries after treatment of rudimentary horn pregnancies. We report the successful management of a case of non-communicating rudimentary horn pregnancy by local injection of methotrexate followed by complete laparoscopic excision along with a review of the literature.Case presentationThe patient was a 29-year-old Japanese woman, gravida 2, nullipara. She was diagnosed with a left unicornuate uterus with a right non-communicating rudimentary horn on hysterosalpingography and magnetic resonance imaging. A gestational sac with a heartbeat was observed in the right rudimentary uterine horn at 6 weeks of gestation. A diagnosis of ectopic pregnancy in a non-communicating rudimentary horn was made. Color Doppler detected multiple blood flow signals around the gestational sac, which were clearly increased compared to the left unicornuate uterus. Her serum human chorionic gonadotropin level was 104,619 mIU/ml. A 100 mg methotrexate injection into the gestational sac was administered, and laparoscopic surgery was performed on day 48 after the methotrexate treatment. The right rudimentary horn and fallopian tube were successfully excised with minimal bleeding. A spontaneous normal pregnancy was established 6 months after the surgery. The pregnancy was uneventful, and a baby girl was born by elective cesarean section at 38w0d.ConclusionCombined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.