Rudimentary Uterine Horn Research Articles

Rupture of noncommunicating rudimentary uterine horn pregnancy

BACKGROUND: We present a rare case of pregnancy in a noncommunicating rudimentary horn that ruptured at 20 weeks. CASE: A 30-year-old woman presented with a history of two spontaneous abortions. An ultrasound scan showed a bicornuate uterus, with one normal and one hypoplastic horn. Hysterosalpingography revealed a single uterine cavity with only one tube, suggesting a unicornuate uterus. Hysteroscopy and laparoscopy were recommended but declined. She presented again 2 months later at 7 weeks’ gestation. A single intrauterine pregnancy in the hypoplastic right horn was diagnosed. A transvaginal scan showed a single cervical canal in continuity with the left uterine horn, which led to the suspicion of a pregnancy in a rudimentary horn. The option of pregnancy termination was offered. A laparoscopy was repeatedly suggested but declined. Excision of a ruptured noncommunicating rudimentary horn and ipsilateral salpingectomy were performed after an emergency laparotomy at 20 weeks because of the sudden onset of abdominal pain and signs of shock. CONCLUSION: Although a rudimentary horn pregnancy had been suspected before the laparotomy, the patient presented as a clinical emergency. This report, like others, indicates that prompt diagnosis and immediate removal of the rudimentary horn is lifesaving.

Pulmonary endometriosis in a patient with unicornuate uterus and noncommunicating rudimentary horn

Objective: To report a rare case of a patient with catamenial hemoptysis, secondary infertility, and endometriosis associated with a unicornuate uterus and noncommunicating rudimentary horn. Design: Case report. Setting: University hospital. Patient(s): A 29-year-old woman who developed progressive catamenial hemoptysis and secondary infertility was evaluated at the University Hospital of Crete. Intervention(s): The complete history, laboratory data, laparoscopic findings, and chest magnetic resonance image of this patient were analyzed. A GnRH agonist, leuprolide acetate, was successfully administered. Main Outcome Measure(s): Diagnosis and appropriate treatment of pulmonary endometriosis in a patient with rudimentary uterine horn. Result(s): Treatment with a GnRH agonist achieved suppression of both menstruation and hemoptysis. After 6 months of normal menstrual activity, the symptoms reappeared. The patient was again treated with leuprolide acetate (3.75 mg/mo IM) for 6 months and remained asymptomatic. In fact, the patient became pregnant after cessation of therapy. Finally, the patient was treated successfully with removal of the rudimentary uterine horn during cesarean section. Three-year follow-up showed disappearance of the chest symptoms. Conclusion(s): Pulmonary endometriosis and unicornuate uteri are rare. To our knowledge, this is the first case of catamenial hemoptysis with a congenital müllerian anomaly. We describe successful management using a combination of GnRH agonist and surgical resection of the rudimentary uterine horn.

A Case of Uterine Leiomyomas in both Rudimentary Uterine Horns in a Woman with the Mayer-Rokitansky-Kuster-Hauser Syndrome

Mayer-Rokitansky-Kuster-Hauser syndrome occurs in only approximately 1 in 4000-5000 female births. Leiomyoma is a rather common occurrence in the normal uterus, but extremely rare in mullerian remnants. Leiomyoma should be considered low on the list of differential diagnosis of pelvic mass in women with Mayer-Rokitansky-Kuster-Hauser syndrome. We have experienced a case of Mayer-Rokitansky-Kuster-Hauser syndrome associated with lei´Omyomas arising from both rudimentary uterine horns and report it with a brief review of literatures.

Successful laparoscopic surgery of unicornuate uterus with rudimentary uterine horn (non-communicating)

Successful laparoscopic surgery of unicornuate uterus with rudimentary uterine horn (non-communicating)

Reply to Anwar & Chin (Comment on: Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture)1

Reply to Anwar & Chin (Comment on: Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture)1

Comment on: Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture (Morgans & Scott, Gynaecological Endoscopy 1999; 8: 293-5)

Comment on: Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture (Morgans & Scott, Gynaecological Endoscopy 1999; 8: 293-5)

Laparoscopic resection of a uterine horn following a pregnancy and rupture at 30 weeks' gestation

Objective To report the case history of a patient who underwent a laparoscopic resection of a rudimentary uterine horn following a pregnancy and rupture at 30 weeks' gestation.MethodsThe clinical records of the patient were reviewed.ResultsThe clinical and radiological findings demonstrated a unicornuate uterus, without a patent connection between the rudimentary uterine horn, and the cervix. The patient's first pregnancy occurred in the rudimentary uterine horn which ruptured at 30 weeks' gestation. A haematometra developed 17 months after an emergency Caesarean section, and she subsequently underwent a laparoscopic resection of the rudimentary uterine horn.ConclusionThis case report describes a minimal access procedure being carried out to treat a congenital anomaly of the uterus following a major obstetric complication.

Conservative treatment for a noncommunicating rudimentary uterine horn

Conservative treatment for a noncommunicating rudimentary uterine horn

Use of the ultrasonically activated scalpel in laparoscopic resection of a noncommunicating rudimentary uterine horn

Objective This case report describes for the first time a method of laparoscopic removal of a rudimentary uterine horn using the ultrasonically activated scalpel. Conclusions This instrument cuts and coagulates with minimal tissue injury and excellent haemostasis and, in conjunction with the electronic morcellator, significantly reduced our operating time. This report also highlights the common misdiagnosis of congenital müllerian anomalies, leading to increased morbidity and inappropriate surgery. We would like to alert clinicians to the importance of adequate investigation, including hysteroscopy and magnetic resonance imaging, to optimize surgical evaluation and maximize future reproductive potential.

Rokitansky-Kuster-Hauser syndrome associated with chromosomal abnormality and fibroid arising from the rudimentary uterine horn

Rokitansky-Kuster-Hauser syndrome associated with chromosomal abnormality and fibroid arising from the rudimentary uterine horn

Twin pregnancy in a rudimentary uterine horn diagnosed by ultrasound and managed laparoscopically before rupture

ObjectiveTo describe a case of a pregnancy in a rudimentary horn, diagnosed by ultrasound and treated entirely with laparoscopic surgery.SubjectA 33‐year‐old multiparous patient, who had conceived after gamete intrafallopian transfer to the left fallopian tube.InterventionAt 9 weeks' gestation, because of mild right‐sided pain, pregnancy in a right rudimentary uterine horn, surrounded by very little endometrium, was diagnosed by means of ultrasound. At laparoscopy, the diagnosis was confirmed and the main body of the uterus was separated from the rudimentary horn containing the pregnancy. The tissue was then removed via one of the abdominal ports.ConclusionPregnancy in a rudimentary uterine horn diagnosed by ultrasound before rupture, can be treated using advanced laparoscopic surgery, with the associated benefits of this technique.

MRI Sensitivity in Detecting Uterine Agenesis in Cases of Vaginal Agenesis

Background Vaginal agenesis may be associated with anomalies of the upper mullerian duct system such as rudimentary uterine horns or absence of a uterus. In the Mayer-Rokitansky-Kuster-Hauser Syndrome, approximately 90% of patients will have some mullerian structures. It has been demonstrated that rudimentary uterine horns have the potential for reproductive function with the utilization of assisted reproductive technologies, and therefore it is important to diagnose uterine structures both to control retrograde menses and for preservation of future fertility. The evaluation of a patient with vaginal agenesis has classically consisted of a history. physical exam, ultrasound, and/or MRI. MRI is particularly useful in the setting of vaginal atresia with hematocolpos or other obstructive utero-vaginal anomalies; however, its use in detecting uterine remnants is less well established. Traditionally, laparoscopy has not been considered a necessary step in evaluating patients with vaginal agenesis who are asymptomatic and have a negative MRI. We hypothesize that in cases of vaginal agenesis with or without symptoms of pelvic pain, surgical evaluation is a necessary tool for the detection of rudimentary uterine structures so that menstrual suppressive therapy can be initiated to avoid retrograde menses, endometriosis, adhesions, and possible future infenility. Methods All cases of vaginal agenesis referred to one gynecologist (MRL) at Children's Hospital and Brigham and Women's Hospital between 1993–1997 were reviewed. Subjects who had an MRI to assess mullerian structures were identified and their clinical charts reviewed to correlate physical exam, MRI reports, and operative findings. Results 22 cases of vaginal agenesis were identified. On physical exam, all of the women had absence of the vagina and only two (9%) had a midline abdominal mass on recto-abdominal exam. Of the 22 women, 14 underwent laparoscopy or laparotomy and 12 (86%) had some uterine structure(s). 13 of the 22 women (59%) had both MRI and an operative procedure to further delineate mullerain structures. In this subgroup. MRI successfully predicted uterine anomalies in four cases (31%) and lack of any uterine structures in one case (8%). In the remaining eight cases (75%), MRI diagnosis did not correlate with diagnosis on laparoscopy. Three had an MRI diagnosis of a hypoplastic midline uterus but on laparoscopy were found to have bilateral rudimentary uterine horns. Five women (42%) had an MRI showing no uterine structures, with the subsequent laparoscopy showing either unilateral or bilateral rudimentary uterine horns. Of these 5 women, 2 (40%) had symptoms of pelvic pain, and 3 (60%) had no symptoms of pelvic pain. Using laparoscopy as the gold standard. MRI was found to have a sensitivity of 31% a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 11%. Conclusions Laparoscopy is an excellent method for diagnosing uterine structures associated with vaginal agenesis in women with or without symptoms of pelvic pain. In this small series, MRI had a low sensitivity (31%) for detecting uterine structures, panicularly rudimentary uterine horns in cases of vaginal agenesis. Laparoscopy is useful in the routine assessment of patients with vaginal agenesis either in conjunction with MRI or alone so as to accurately define the anatomy and preserve options for reproductive function.

Rudimentary Uterine Horn Pregnancy Diagnosed with Magnetic Resonance Imaging

Rudimentary Uterine Horn Pregnancy Diagnosed with Magnetic Resonance Imaging

Rupture of a rudimentary uterine horn at 19 weeks' gestation

Rupture of a rudimentary uterine horn at 19 weeks' gestation

Laparoscopic management of a rudimentary uterine horn pregnancy

Laparoscopic management of a rudimentary uterine horn pregnancy

Laparoscopic resection of a noncommunicating rudimentary uterine horn

Two women had infertility due to a symptomatic unicornuate uterus associated with rudimentary contralateral horn. Both carried successful pregnancies after laparoscopic resection of the horns.

A case of pregnancy in a woman with cloacal dysgenesis and a rudimentary uterine horn

Cloacal dysgenesis is frequently associated with uterine anomalies. We report a case of pregnancy which resulted in an abortion in a woman with a persistent cloaca. Presumptive diagnosis before operation was ectopic pregnancy of the left tube. Postoperatively, the site of implantation of the conceptus was found to be the cavity of a unicornuate uterus in association with a rudimentary horn, the presence of which misled us to diagnose an ectopic pregnancy.

Mayer-Rokitansky-Kuster-Hauser Syndrome Diagnosed by Magnetic Resonance Imaging in a 15-Year-Old Girl

Study ObjectiveMayer-Rokitansky-Kuster-Hauser syndrome diagnosed by magnetic resonance imaging (MRI) in a 15-year-old girl with primary amenorrhea is reported. DesignThe presentation, MRI, and the subsequent evaluation and treatment of an adolescent female patient with Rokitansky syndrome are described. Correlation is made with previous clinical, pathologic, and imaging reports in the literature. SettingAn adolescent girl with primary amenorrhea was referred to our institution for completion of her diagnostic work-up. Previous limited evaluations suggested the presence of anomalies of the genitourinary tract. Further delineation of the suspected congenital defects was necessary. ParticipantThe 15-year-old female patient was evaluated by the gynecology service. Diagnostic radiology and pediatric urology were consulted. InterventionsMRI, physical examination under anesthesia, and cystoscopy were performed. After initial nonoperative treatment, the patient underwent hysterectomy and sigmoid vaginoplasty. Main Outcome MeasuresThe patient's primary amenorrhea was explained. Mayer-Rokitansky-Kuster-Hauser syndrome was diagnosed. Vaginal agenesis and widely separated rudimentary uterine horns were well shown by the MRI. Associated skeletal anomalies were noted. A treatment plan was initiated based on a good understanding of the anatomic defects. ResultsThe MRI and physical examination firmly established the diagnosis. The patient was counseled and managed conservatively at first. Hysterectomy and vaginoplasty were subsequently performed. ConclusionsMayer-Rokitansky-Kuster-Hauser syndrome is an unusual mullerian-duct anomaly that is a cause of primary amenorrhea. It can be confidently and noninvasively diagnosed with MRI. The MRI demonstration of vaginal, cervical, and uterine morphology contributes significantly to treatment planning and patient management.

Laparoscopic excision of a noncommunicating rudimentary uterine horn

Laparoscopic excision of a noncommunicating rudimentary uterine horn

HERNIA UTERUS INGUINALE ASSOCIATED WITH UNILATERAL RENAL AGENESIS

We report a patient with a rudimentary uterine horn, fallopian tube and ovary in an inguinal hernia. Associated with this abnormality the patient had ipsilateral renal agenesis and a unicornuate uterus.