Rupture Of Horn Research Articles

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.

Technical notes surgical treatment of a ruptured interstitial pregnancy

Non-tubal ectopic pregnancies represent fewer than 10% of all ectopic pregnancies. However, they are associated with a high rate of mortality due to late diagnosis and uterine horn rupture which requires radical emergency surgical management. Cornuectomy via laparoscopy is a treatment of choice. We provide here a simple description of laparoscopic cornuectomy using an Endo GIA stapling system: the Endo GIA® automatic forceps. It has the advantage of removing the mass, suturing, and achieving satisfactory haemostasis in a single step.

Management of 14 patients with cornual heterotopic pregnancy following embryo transfer: experience from the past decade

ObjectiveThere are two major management approach for cornual heterotopic pregnancy, transvaginal cornual embryo reduction with ultrasound guidance, or laparoscopic cornual resection. This no consensus on the optimal management for cornual heterotopic pregnancy. Here, we are trying to determine the optimal management approach for patients with viable cornual heterotopic pregnancy following embryo transfer.MethodsThis is a retrospective cohort study conducted at the locally largest reproductive center of a tertiary hospital. A total of 14 women diagnosed as viable cornual heterotopic pregnancy following embryo transfer. Six patients were treated with cornual pregnancy reduction under transvaginal ultrasound guidance without the use of feticide drug (treatment 1), and eight patients were treated with laparoscopic cornual pregnancy resection (treatment 2).ResultsAll 14 patients of cornual heterotopic pregnancy following embryo transfer due to fallopian tubal factor, among which, 12 patients had cornual pregnancy occurred in the ipsilateral uterine horn of tubal pathological conditions. Nine (64.29%) showed a history of ectopic pregnancy. Thirteen (92.86%) patients were transferred with two embryos and only one patient had single embryo transferred. Six patients received treatment 1, and 2 (33.33%) had uterine horn rupture and massive bleeding which required emergency laparoscopic surgery for homostasis. No cornual rupture occurred among patients received treatment 2. Each treatment group had one case of spontaneous miscarriage. The remaining 5 cases in treatment 1 group and the remaining 7 cases in treatment 2 group delivered healthy live offspring.ConclusionPatients with tubal factors attempting for embryo transfer, especially those aiming for multiple embryos transfer, should be informed with risk of cornual heterotopic pregnancy and the subsequent cornual rupture. Compared with cornual pregnancy reduction under transvaginal ultrasound guidance, laparoscopic cornual resection might be a favorable approach for patients with viable cornual heterotopic pregnancy.

Unusual Causes of Hemoperitoneum: A Case Series of Fundal and Uterine Horn Rupture

Unusual Causes of Hemoperitoneum: A Case Series of Fundal and Uterine Horn Rupture

Study of reliability of meniscus damage signs using high intensity 1,5 tesla mri compared to the results of arthroscopic interventions in acute and obsolete knee injury

Annotation. Among the large joints, the knee joint is most often injured, which is due to the peculiarities of its structure and functional loads in the process of human life. The most common injuries are meniscus damages of the knee joint, that is the evidence of steady increase in the number of partial arthroscopic meniscectomies, which have become the most common orthopedic procedure. Diagnosis of meniscus damage is based on the results of clinical examination, sonography and MRI. Increasing the resolution of MRI machines, improving the technique of their implementation allows to improve the quality of diagnosis of meniscus ruptures and improve the results of surgical arthroscopic interventions on the knee joint. The aim of the study – to demonstrate the capabilities of high-intensity 1.5 Tesla MRI and to study the reliability of MRI signs of meniscus damage in comparison with the results of arthroscopic interventions in acute and chronic knee joint injury. The work is based on the results of MRI examinations and arthroscopic interventions of 247 patients with acute and chronic knee joint injuries aged 14 to 59 years. Medial meniscus damage was diagnosed in 206 (83.41%) patients. Lateral meniscus ruptures were diagnosed in 34 patients (13.76%). Simultaneous damage of both menisci was found in 7 (2.83%) patients. It was found that ruptures of the medial meniscus by location were: the root of the posterior horn of the medial meniscus in 4 (1.94%) patients, ruptures of the posterior horn in 82 (39.81%) patients. Injury of the posterior horn with the transition to the body of the meniscus was diagnosed in 117 (56.79%) patients. Anterior horn ruptures were detected in 3 (1.46%) patients. With ruptures of the lateral meniscus: damage of the root of the posterior horn of the lateral meniscus was found in 2 (5.88%) patients, damage of the posterior horn in 9 (26.47%) patients. Posterior horn rupture with transition to the body of the meniscus was diagnosed in 19 (55.89%) patients. Isolated ruptures of the anterior horn were found in 4 (11.76%) patients. Simultaneous damage to both menisci was found in 7 (2.83%) patients. 206 (83.40%) partial meniscectomies were performed during arthroscopic interventions and meniscus suturings were performed over 41 (16.60%) patients. In order to identify meniscus damage and their location during MRI knee joint investigations 21 pseudo-positive and 18 pseudo-negative cases of diagnosis were revealed. The sensitivity of MRI for defining damage and localization of meniscus rupture was 91,7%, specificity 92,6%, diagnostic accuracy 94,8%. Discrepancies in the evaluation of meniscal damage most often occurred in cases of their combined ruptures and degenerative changes in the menisci.

Rare case of Bicornuate Uterus with Fetal Death in a Multipara woman

Congenital uterine anomalies result from defect in unification of the müllerian duct during intrauterine fetal life. Pregnancy in such abnormalities associated with poor outcome including rudimentary horn rupture, miscarriage, hemorrhage and death. The diagnosis is also difficult in lower resource settings and case management requires good skills in surgery. We present a case with failed labour induction and misdiagnosis of pregnancy in rudimentary horn of bicornuate uterus. This case has tremendously delay in diagnosis and management, however the final decision of conducting surgery was implicit successful.

Ruptured Rudimentary Horn Pregnancy and the Missing Hemoperitoneum: An Unexpected Presentation

Background: Pregnancy in the rudimentary horn of a unicornuate uterus is an extremely rare obstetric complication and usually results in rupture in the second trimester, with an acute clinical presentation. The authors present a rare case of a ruptured rudimentary horn pregnancy (RHP) without classical hemoperitoneum. Case: A 22-year-old primigravida at 21 weeks gestation was referred as a case of intrauterine fetal death. Magnetic resonance imaging indicated a possible rudimentary horn rupture. Results: Intraoperatively, it was noted that there was a ruptured right RHP with a macerated fetus, and 100 cc of clotted blood was contained in a pseudosac formed by the surrounding viscera and peritoneum. After surgical intervention, the patient had an uneventful postoperative period. Conclusion: A ruptured RHP can occur unexpectedly with stable hemodynamics. (J GYNECOL SURG 34:43)

An Unusual Case of Twin Pregnancy associated with Rudimentary Horn Rupture

ABSTRACT Twin pregnancy in association with rudimentary horn pregnancy is extremely rare and more so in spontaneous conceptions. Rudimentary horn pregnancy coexistent with an intrauterine pregnancy usually results in rupture of the rudimentary horn and death of the correspondent twin. We report an unusual case of twin pregnancy following spontaneous conception in association with rudimentary horn rupture. How to cite this article Gupta V, Nanda A, Tandon A, Ahmed A. An Unusual Case of Twin Pregnancy associated with Rudimentary Horn Rupture. J South Asian Feder Obst Gynae 2017;9(2):123-124.

Asymptomatic Rupture of Term Non-communicating Rudimentary Horn of Uterus: A Case Report

A Rudimentary horn is a rare form of congenital uterine anomaly, resulting from an arrest in the development of one of the Mullerian ducts with inappropriate fusion with the other side. In most of the cases no direct communicating channel exists between the two parts of the uterus. Pregnancy in the rudimentary horn represents a rare form of ectopic gestation and is thought to result from transperitoneal migration of spermatozoa or the fertilized ovum. Most patients with rudimentary horn pregnancy present in second trimester with hemorrhagic shock due to rupture of horn. Diagnosis of the rudimentary horn may be done with magnetic resonance imaging or 3D, 4D ultrasonography but confirmation of diagnosis is usually surgical at laparoscopy or laparotomy. We report a case with provisional diagnosis of a case of primigravida with 40+ weeks pregnancy with transverse lie along with placenta praevia and intrauterine fetal death. But at laparotomy it revealed a ruptured pregnant non-communicating horn of uterus.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 53-55

Ruptured Ectopic Pregnancy in Accessory Horn

ABSTRACTPregnancy in an accessory horn is rare. The incidence of uterine congenital anomalies: Müllerian defects in the normal fertile population are 3.2%. Incidence in pregnancy is 1 in 76,000 to 150,000 pregnancies. There are chances of high rate of spontaneous abortion, preterm labor, intrauterine growth retardation, intraperitoneal hemorrhage, and uterine rupture. Unicornuate uterus is a type II classification with unilateral hypoplasia or agenesis. It can be further classified into communicating, noncommunicating, without cavity, and unicornuate uterus.Mother and fetus are at grave risk due to rupture of horn in second trimester of pregnancy. We report a case of ruptured accessory horn pregnancy at gestation of 18 weeks. Emergency laparotomy was done and the accessory horn was excised. Patient's postoperative recovery was uneventful.How to cite this articleSindhura B, Sailakshmi, Akash S. Ruptured Ectopic Pregnancy in Accessory Horn. J Med Sci 2016;2(4):70-72.

Term Pregnancy with a Live Fetus in Non-communicating Rudimentary Horn with Placenta Percreta.

Abnormalities of embryogenesis of mullerian duct system resulting in congenital anomalies of female genital tract are relatively common [1]. The prevalence of congenital uterine anomalies in the general population is 6.7 % [2]. In women with a history of repeated pregnancy loss, the rate of mullerian anomalies increases to 3–25 % [2, 3]. Unicornuate uterus accounts for 5 % of all mullerian anomalies. Unicornuate uterus is thought to occur in general population at a rate of 1:4,020 [1]. Unicornuate uterus is a type II mullerian anomaly according to the American Fertility Society classification system [1, 4] that occurs due to a complete or partial failure of development of one mullerian duct and incomplete fusion with contralateral side [1]. The failed mullerian duct fusion leads to the formation of an isolated hemiuterus without a contralateral structure (in complete failure) to various degrees of a rudimentary horn (in partial failure) [1]. This rudimentary horn is subclassified into communicating or non-communicating with uterine cavity and a horn with no cavity [1]. In about 84 % of these cases, a contralateral rudimentary horn exists, almost always of a non-communicating type [1, 5]. The attachment of the rudimentary horn may vary from a fibromuscular band (separated variety) to an extensive fusion between the two horns where there is no external separation between them [4, 6]. This was a case with an extensive fusion between the two horns. Pregnancy in such a rudimentary horn is extremely rare, tenfold less common than an abdominal pregnancy [1, 2, 4]. The natural course of a rudimentary horn pregnancy is rupture during the first or mid-second trimester with potentially life-threatening bleeding [1, 5]. In the majority of cases, horn rupture occurs before 20 weeks of gestation [7]; reports of rupture varying from 5 to 37 weeks are described [1, 7]. The uterine wall being thicker and more vascular, bleeding is more severe in rudimentary horn pregnancy rupture, therefore it commonly manifests with acute abdominal pain and intraperitoneal hemorrage [1, 7].

An autopsy report on a ruptured rudimentary horn (uterine anomaly) with ectopic pregnancy

The rudimentary horn is a rare developmental anomaly of the Müllerian duct. Ectopic pregnancy in the rudimentary horn is estimated to occur in one out of 76,000–150,000 pregnancies. A 30-year-old primigravida suddenly collapsed after 3 days of continuous abdominal pain. Emergency laparotomy revealed a massive intraperitoneal hemorrhage and fetal demise. The growth of the fetus after 19 weeks of gestation is believed to have caused the rudimentary horn rupture, thereby rapidly leading to hemorrhagic shock in the mother and ischemic death in the fetus. This is the first autopsy report on maternal death due to the rudimentary horn or other Müllerian duct anomalies, which emphasizes the need for forensic pathologists to consider this condition as a possible cause of unexpected death in fertile women. In addition, it is very important for clinicians to detect Müllerian duct anomalies by sonography during routine obstetric examinations, and promptly diagnose anomaly related ectopic pregnancies in women displaying symptoms of an acute abdomen, intraperitoneal hemorrhage, or shock in the emergency practice.

Torsion of a rudimentary horn pregnancy—an unusual case presentation

Aplasia of the mullerian ducts during foetal life can result in the formation of a unicornuate uterus. This can be associated with varying degrees of a rudimentary horn. Of the female population, 5.5 % is thought to have a uterine abnormality, but only 0.1 % has this specific formation [1]. Unicornuate uteri with rudimentary horns are susceptible to many gynaecological and obstetric complications, such as infertility, endometriosis, urinary tract anomalies and premature delivery [2]. They can also, although seldom, undergo horn torsion [3]. Development of a pregnancy in a rudimentary horn is rare occurring in only 1/76,000–150,000 cases [4]. It is made possible when migration of the spermatozoa occurs through the abdominal cavity [5]. Pregnancy carries with it the risk of horn rupture, which can be fatal causing major haemorrhage. Rupture occurs in 80–90 % of cases at midtrimester [6]. When a pregnancy in a rudimentary horn is diagnosed, excision of the horn is often necessary to prevent this, often through a laparotomy and, only more recently, through laparoscopy [5]. Formation of a large uterine horn capable of sustaining a pregnancy is particularly uncommon. The neonatal survival in rudimentary horn pregnancies is only 2 % [6]. Here, we present a case of a patient who developed a pregnancy in a large rudimentary horn with the musculature capable of maintaining a viable pregnancy, but which had also undergone torsion, and who later required laparoscopic management for removal of products of conception. To the best of our knowledge, this is the first case report of the management of a torted rudimentary horn pregnancy in the literature.

Uterine Prolapse with Associated Rupture in a Podengo Bitch

A case of uterine prolapse coexisting with uterine horn rupture in a 3-year-old Portuguese Podengo bitch, which is an uncommon occurrence, is described. The female was presented with a history of recent parturition, with delivery of four healthy puppies that were normally tended and nursed. The situation developed after an uneventfully pregnancy, and no direct causative factor was identified. The duration of the prolapse was unknown, but considered to be recent because of the swollen reddish appearance of the tubular everted mass. No foetus was found in the uterus or the abdominal cavity. The female was presented in good physical condition, without signs of shock or haemorrhage. During surgical treatment, the uterus was replaced to its normal position followed by ovary-hysterectomy at 12 h from admittance.

Recurrence of Uterine Rupture in a Pseudo-Unicornuate Uterus at 17 Weeks of Amenorrhea: Case Report and Literature Review

Pregnancy in a rudimentary horn is a very rare condition. It is responsible for several complications. Prognosis is reserved because the natural evolution generally leads to a cataclysmic uterine rupture at the beginning of the second trimester. Classically, the treatment after foetal extraction consists of ablation of the rudimentary horn and associated fallopian tube. We report the obstetric outcome of a patient with history of rudimentary uterine horn rupture, the treatment of which was ablation of the rudimentary horn.

Rupture d’une corne utérine rudimentaire non communicante gravide sur un utérus pseudo-unicorne à 23 semaines d’aménorrhée: À propos d’un cas

Pregnancy in the rudimentary horn of a unicornuate uterus is an extremely rare form of ectopic gestation associated with a high risk of uterine rupture. We report the case of a pregnancy developed in a non communicating rudimentary horn of a unicornuate uterus complicated by horn rupture at 23 weeks of amenorrhea showing as an acute abdominal pain and massive hemoperitoneum. This patient's uterine abnormality was known before, as this woman has delivered two years before at term a healthy boy by cesarean section. This past pregnancy was located in the normal horn and the non communicating rudimentary horn seemed at this time normal. This uterine malformation is presented with its gynecological and obstetrical entailments as well as methods that could prevent such outcome.

Récidive d’une rupture utérine sur corne rudimentaire d’un utérus pseudo-unicorne à 25 semaines d’aménorrhée : à propos d’un cas

Pregnancy in a rudimentary uterine horn is a rare event which can be revealed by uterine rupture. Following the fetal extraction, some authors recommend the ablation of the rudimentary horn, in order to limit the risk of uterine rupture in case of subsequent pregnancy in the same horn. We report the obstetrical outcome of a patient with a history of rudimentary uterine horn rupture the treatment of which was conservative.