Uterine Rupture of a Patient With Rudimentary Horn Pregnancy at 26th Gestational Weeks Diagnosed via Magnetic Resonance Imaging: a Case Report

Objective: Pregnancy 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: We 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 grams was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed.Conclusion: Rudimentary 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. Due to the serious maternal and fetal complications, its detection at an early week may be life-saving.

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 as a Rare Etiology of Secondary Dysmenorrhea: A Case Report

Congenital uterine anomalies are an uncommon type of female genital malformations caused by abnormal development of müllerian ducts during embryogenesis. Patients with an obstructive uterine anomaly have a higher risk of developing gynecological and obstetric complications that may present at menarche or later in life. We present a case of severe dysmenorrhea in a young teenager caused by obstructive hematometra in a noncommunicating horn of the unicornuate uterus. A differential diagnosis of a possible anomaly was made using 2-dimensional pelvic ultrasonography, which was later confirmed using MRI that revealed an anomalous uterine cavity with a single left-sided cornua communicating with the cervix and a distended right-sided rudimentary horn. She underwent a right salpingectomy with rudimentary horn excision, which was successfully managed laparoscopically. This case emphasizes the importance of physicians being cognizant in identifying patients with uterine anomaly to provide appropriate treatment and prevent adverse reproductive outcomes.

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

Background Pregnancy 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 presentation The 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. Conclusion Combined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.

Co-Existence of a Rudimentary Non-Communicating Horn with a Unicornuate Uterus in Association with 2 Components of the VACTERL Association: A Case Report

The prevalence of congenital uterine anomalies has been reported as 6.7% in the general population. The unicornuate uterus accounts for 2.4-13% of all Mullerian anomalies and has a prevalence of 1:1000. A unicornuate uterus may be present alone or with a rudimentary horn and 75-90% of rudimentary horns are non-communicating. A pregnancy in the rudimentary horn may lead to uterine rupture, haemoperitoneum with a high risk of maternal mortality. The association of a unicornuate uterus with a non-communicating uterine horn to the VACTERL association of defects (vertebral anomalies, anorectal malformations, cardiovascular anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies and limb defects) has been described only twice in the literature. We report a patient who was born with an extra thumb and had a trachea-bronchial remnant with oesophageal stenosis that were both operated on earlier, and they were associated with a non-communicating rudimentary uterine horn. To the best of our knowledge, this is the third case reported in the literature of a VACTERL association to a unicornuate uterus with a non-communicating functional rudimentary horn. Given the high risk for the patient if pregnant an early diagnosis is paramount. This case highlights the importance of considering Mullerian defects in the young patient born with components of the VACTERL association.

Unicornuate uterus with a functional non-communicating horn in adolescent

Common causes of pelvic pain are primary dysmenorrhoea, Müllerian duct anomalies, outflow obstruction, leiomyoma, endometriosis and adenomyosis. Unicornuate uterus with a rudimentary horn is a rare congenital malformation of the female genital tract, asymptomatic because of lack of functional endometrium. This study presents a rare case of a non-communicating functional rudimentary horn. A 16-year-old unmarried Yemeni female adolescent with a history of irregular painful menstrual period visited Obstetrics and Gynaecology outpatient clinic. Pelvic ultrasound was conducted showing an asymmetrical uterine configuration with the non-communicating rudimentary horn on the right side. Laparoscopic excision of the horn was planned for the patient. Non-communicating rudimentary horn with functional endometrium should be considered as a differential diagnosis in the female adolescent with obstructive uterine symptoms. Early diagnosis is crucial. Using the laparoscopic approach, an expert surgeon prefers definitive management to excise the rudimentary horn.

A rare case of persistent urogenital sinus in an adult woman associated with unilateral rudimentary horn with ipsilateral renal agenesis and contralateral dermoid cyst

Persistent urogenital sinus (PUGS) is an uncommon developmental cloacal anomaly, with Incidence of 0.6 in 10000 female births. Herein we depict the case of a 22-year of age lady who presented with Infertility for 16 months with dyspareunia and was found to have Persistent urogenital sinus associated with other urogenital anomalies as unilateral rudimentary horn with ipsilateral renal agenesis and contralateral dermoid cyst. The patient was successfully treated with the excision of the sinus, the rudimentary horn and the dermoid cyst.

A case report on ruptured rudimentary horn ectopic pregnancy

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. This malformation results from the defective fusion of the duct with the contra-lateral side. This rudimentary horn may or may not have functional cavity. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. IT is a rare condition that can lead to a catastrophic outcome when it rupture. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. Pregnant rudimentary horn can present with wide range of symptoms that may be similar to ectopic pregnancy or may remain silent with features of normal pregnancy.1-2 We report a case of ruptured non-communicating rudimentary horn at 19 weeks in pregnant lady. In our opinion, routine excision of rudimentary horn should be undertaken during non-pregnant state laparoscopically. However, those women who refuse should be adequately counselled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.