Diagnostic and Laparoscopic Management of Unicornuate Uterus with Rudimentary Horn

Els van Doorn, Rainer Kimmig, Bahriye Aktas

Department of Obstetrics and Gynecology, University of Essen, Essen, Germany.

DOI: 10.4236/crcm.2014.36084                

Abstract

We describe here a case report of a female patient with a unicornuate uterus with noncommunicating left rudimentary horn. The patient presented herself to us due to persistent lower abdominal pains, primarily dysmenorrhea and suspected internal genital endometriosis. Further to additional diagnosis and imaging by vaginal and abdominal ultrasound and abdominal MRI, a suspected rare congenital malformation of the genital tract was established. A normal vagina with cervical system without pathological findings was presented during the operation. The diagnostic hysteroscopy and laparoscopy indicated an intact right unicornuate uterus with a regular tube and ovary. A left rudimentary horn, noncommunicating with cervix and vagina was also presented, also together with a regular tube and ovary. The chromopertubation carried out proved the patency of the right tube. The decision was taken intraoperatively to remove the left rudimentary horn with ipsilateral tube. The surgery could be carried out without complications. We are reporting a patient with persistent lower abdominal pain, who desires to have children, to conceive with a unicornuate uterus and left rudimentary horn with retrograde menstruation and proliferative endometrium. Surgical minimal invasive treatment by laparoscopically removing of the left rudimentary horn and tube took place.

Keywords

Unicornuate Uterus, Rudimentary Horn, Diagnostic and Laparoscopic Management, Endometriosis, Retrograde Menstruation

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kiechle, M., Beinder, E., Bosinski, H.A.G., Brucker, C., Bühren, C. and Chaoui, R. (2007) Gynäkologie und Geburtshilfe. Elsevier GmbH, Urban & Fischer Verlag, 33-35.
[2]	Geibel, D. and Rimbach, S. (2013) Uterine Fehlbildungen. ÄP Gynäkologie, 2, 16-21.
[3]	Poel, G., Aggarwal, A., Devi, K., Takkar, N., Saha, P.K. and Huria, A. (2005) Unicornuate Uterus with Non-Communicating Rudimentary Horn—Different Clinical Presentations. Journal of Obstetrics and Gynaecology of India, 55, 155-158.
[4]	(2010) Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG): S1-Leitlinie Gynäkologie 015/052. Weibliche Genitale Fehlbildungen.
[5]	Liatsikos, S.A., Tsikouras, P., Souftas, V., Ammari, A., Prassopoulos, P., et al. (2010) Diagnosis and Laparoscopic Management of Rudimentary Uterine Horn in a Teenage Girl, Presenting with Haematometra and Severe Endometriosis: Our Experience and Review of Literature. Minimally Invasive Therapy and Allied Technologies, 19, 241-247. http://dx.doi.org/10.3109/13645701003644491
[6]	Fuchs, F., Guillot, E., Cordier, A.-G., Chis, C., Raynal, P. and Panel, P. (2008) Rupture of Non-Communicating Rudimentary Pregnant Uterine Horn in a Pseudo-Unicornuate Uterus at 23 Weeks of Amenorrhea: Case Report. Elsevier, 400-402.
[7]	Daskalakis, G., Pilalis, A., Lykeridou, K. and Antsaklis, A. (2002) Rupture of Non-Communicating Rudimentary Uterine Horn Pregnancy. Obstetrics Gynecology, 100, 1108-1110. http://dx.doi.org/10.1016/S0029-7844(02)02153-1
[8]	Lennox, G., Pantazi, S., Keunen, J., Van Mieghem, T. and Allen, L. (2013) Minimally Invasive Surgical Management of a Second Trimester Pregnancy in a Rudimentary Uterine Horn. Journal of Obstetrics and Gynaecology Canada, 35, 468-472.
[9]	Handa, Y., Hoshi, N., Yamada, H., Wada, S., Kudo, M., Tsuda, K., et al. (1999) Tubal Pregnancy in a Unicornuate Uterus with Rudimentary Horn: A Case Report. American Society for Reproductive Medicine, Elsevier, 72, 354-356.
[10]	Jayasinghe, Y., Rane, A., Stalewski, H. and Grover, S. (2005) The Presentation and Early Diagnosis of the Rudimentary Uterine Horn: Review. American College of Obstetricans and Gynecologists, 105, 1456-1467.