RUPTURE ECTOPIC PREGNANCY AT 14 WEEKS IN NONCOMMUNICATING RUDIMENTARY HORN OF UNICORNUATE UTERUS: A CASE REPORT

Rudimentary horn pregnancy is rare but, if occurs it gives a grave risk to the health of the pregnant woman. In most cases it presents in the form of ectopic pregnancy. Despite availability of good USG facility, it is very difficult to timely diagnose rudimentary horn pregnancy. Confirmatory diagnosis made only by laparoscopy or during laparotomy. In the rudimentary horn the constitution of the muscle wall thickness is variable so the pregnancy can be accommodated until late pregnancy. Here we present a case of 24 years female Gravida3 Para2 Live2 with 14 weeks pregnancy presented to us in shock with clinical features of ruptured ectopic pregnancy. On laparotomy we found non-communicating rudimentary horn rupture with dead fetus in peritoneal cavity

Rudimentary horn pregnancy: a rare entity

Unicornuate uterus is the type 2 variety of mullerian duct anomaly resulting in unilateral agenesis or hypoplasia. The hypoplastic (Rudimentary) horn can be functioning or non-functioning and communicating or noncommunicating with the main uterine cavity. Pregnancy in the rudimentary horn is an extremely rare entity. It is often missed at ultrasound in the early trimester, presenting later with massive hemoperitoneum and shock from rupture of the horn.  A “high index of suspicion” is essential to derive at the correct diagnosis. Hence reporting this rare case for emphasizing the importance in early diagnosis and prompt management.

Ruptured rudimentary horn pregnancy: a case report

Uterine anomalies are congenital malformations arising due to embryological mal-development of mullerian ducts. The European society of Human Reproduction and Embryology (ESHRE) classifies these anomalies into 6 classes. Hemi-uterus is one such class of formation defect of mullerian duct with unilateral uterine development; the contralateral part could be either incompletely formed or absent. In a rare form of ectopic pregnancy, implantation can occur in the cavity of a rudimentary horn of the hemi-uterus. Authors report a case of 22-year G2P1L1 with 12 weeks gestation who presented with acute abdomen. Ultrasound showed hemoperitoneum with suspicion of ectopic pregnancy. Laparotomy confirmed the diagnosis of ruptured right rudimentary horn with fetus and placenta in the peritoneal cavity. Immediate laparotomy and excision of the horn with transfusion of blood and blood products saved the patient in the nick of time.

Unicornuate uterus with functional non communicating rudimentary horn: a refractory cause of dysmenorrhea

Mullerian duct anomalies are rare. Unicornuate uterus with a non-communicating rudimentary horn is a rare type of mullerian duct anomaly which occurs due to defective fusion of malformed duct with contralateral duct. The incidence is approximately 1:100000. Patient usually remain asymptomatic due to the absence of functional endometrium in most of the cases. If the rudimentary uterine horn has an endometrium lined uterine cavity and doesn’t communicate externally then the signs and symptoms of obstructed menstruation appears, as soon as menarche begins. It will be associated with severe dysmennorhoea and hematometra. Other complications may be abdominal lump, chronic pelvic pain, infertility, endometriosis, adenomyosis and ectopic pregnancy in rudimentary horn. Authors are presenting a case of refractory dysmenorrhea with lump abdomen in a patient with unicornuate uterus with functional non communicating horn. In a patient with refractory dysmenorrhea mullerian duct anomaly should be kept as differential diagnosis.

An unusual case of ruptured noncommunicating rudimentary horn pregnancy at 10 weeks

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 10 weeks 3 days in a woman. She had a routine USG before pregnancy in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So, a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality.

A rare case of pregnancy in the rudimentary horn of unicornuate uterus (on table diagnosis): a case report

A rudimentary horn with a unicornuate uterus results due to failure of the complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in non-communicating rudimentary horn of unicornuate uterus is a rare form of ectopic gestation and it carries grave consequences for mother and the fetus. The most dreaded complication is rupture during pregnancy which can be life threatening to the mother. The continuation of pregnancy is rare till 3rd trimester and usually ruptures in 2nd trimester. The primary strategy of the management is surgical excision of the rudimentary horn. Here is a case of 24year old, gravida1 with unruptured rudimentary horn pregnancy at gestational age 28 weeks diagnosed on table. IOL (induction of labour) was done with misoprostol for fetal demise and later cesarean section done in view of failed induction. Laparotomy was done and dead fetus with placenta delivered followed by excision of the rudimentary horn. The post-operative period was uneventful. This highlights the need   of an increased awareness of this condition especially in developing countries where most pregnancy are unbooked and uninvestigated as in present case.

Ruptured Rudimentary Horn in Pregnancy at 20 Weeks with Previous Caesserian Section: A Case Report.

Pregnancy in a non communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy . Diagnosis of rudimentary horn and its rupture in a woman with previous caesarean section is difficult . It can be missed on routine ultrasound scan and is usually diagnosed after rupture. We report a case of rupture of rudimentary horn in a patient with previous caesarean section at 20 wks of gestation. Timely laprotomy revealed rupture of left rudimentary horn with massive haemoperitoneum. Excision of horn and blood transfusion saved the patient in a young female with pregnancy is reported for its unusual presentation.

Rupture of Gravid Bicornuate Uterus as a Rare Cause of Acute Abdomen: A Case Report.

Pregnancy in rudimentary horn of uterus is a rare and fatal complication of mullerian duct anomaly. We report one such female presenting with acute abdomen and amenorrhea to highlight the importance of keeping this in differential diagnosis of acute abdomen of women of child bearing age.

Rupture of Term Noncommunicating Rudimentary Horn of Uterus.

Pregnancy in noncommunicating rudimentary horn is rare. It occurs following transperitoneal migration of sperms or zygote. Uterine rupture usually occurs in 70-80% cases in the second trimester by 20 weeks. Neonatal survival in rudimentary horn pregnancy is poor occurring in only about 11% of cases.

Pregnancy in rudimentary horn of uterus.

A 20-year-old primigravida with 3 months amenorrhea presented with complaints of acute abdominal pain. Her vital systemic parameters were stable. On vaginal examination, the patient was provisionally diagnosed of right cornual ectopic pregnancy, which was confirmed sonographically, and taken up for surgery. There was moderate hemoperitoneum and rupture of right horn of uterus with products protruding. The rudimentary horn was excised. The patient was discharged and advised contraception and follow-up.

A Case of Live Birth in a Non-communicating Rudimentary Horn Pregnancy and Rupture after Intrauterine Insemination / 대한주산의학회잡지

Rudimentary horn is a rare uterine anomaly and pregnancy in the rudimentary horn is an extremely rare condition. We report a case of live birth in a non-communicating rudimentary horn pregnancy and rupture. The pregnancy was successfully delivered by cesarean section, with neonatal and maternal survival.

Laparoscopic excision of uterine horn in case of unicornuate uterus firmly attached with non-communicating rudimentary horn / 대한산부인과내시경학회지

Unicornuate uterus is a very rare uterine anomaly caused by developmetal failure of Mullerian duct. This anomay is associated with various degrees of rudimentary horn, which is connected with fibrous band or firmly attached to unicornuate uterus. Different method of operation may be applied according to type of anatomical connection. The unicornuate uterus is commonly associated with severe dysmenorrhea, chronic pelvic pain, and pelvic mass. A case of noncommunicating rudimentary horn firmly attached to unicornuate uterus with severe dysmenorrhea was treated with laparoscopic excison of uterine horn and is presented with brief review of literature.

A case of unruptured rudimentary uterine horn pregnancy at 28 weeks of gestation diagnosed by MRI / 대한산부인과학회지

Pregnancy in rudimentary horn is rare. Rupture tends to occur in the second trimester. Only a few cases of the diagnosis of unruptured third-trimester rudimentary horn pregnancy have been reported. We experienced a case of unruptured rudimentary horn pregnancy at 28+3 weeks gestation confirmed by MRI. Successful delivery of a live male fetus weighing 955g by cesarean section and excision of the rudimentary horn with ipsilateral salpinx were carried.

A Case of Diagnosis and Management of Noncommunicating Rudimentary Horn Pregnancy with the Use of Laparoscopy / 대한주산의학회잡지

A non-communicating rudimentary uterine horn is a rare Mllerian duct anomaly. We experienced a case of unruptured rudimentary uterine horn pregnancy. The patient was diagnosed by laparoscopy and removed by laparoscopic resection of the pregnant rudimentary uterine horn was performed. We report our case with brief review of literatures.

Laparoscopic management of uterine anomaly associated with agenesis of unilateral kidney and pelvic endometriosis: two case reports / 대한산부인과학회지

Unicornuate uterus with a rudimentary horn hematometra and bicornuate uterus with unilateral hematometra is rare congenital anatomic anomalys of the female genital system. these patients present with dysmenorrhea, dyspareunia, pelvic mass, urinary tract anomalies and pelvic endometriosis. We have experienced a case of rudimentary uterine horn hematometra with agenesis of ipsilateral kidney and pelvic endometriosis in a 18 years old girl and a case of bicornuate uterus with unilateral hematometra associated with agenesis of ipsilateral kidney and pelvic endometriosis in a 14 years old girl. and we treated by laparoscopic management. So we report two cases with a brief review of literatures.

Tubal Pregnancy in a Unicornuate Uterus with Rudimentary Horn / 대한산부인과학회잡지

Several cases of ruptured pregnant uterine horn have been documented. However, there have been few reported cases of ectopic tubal pregnancy in a unicornuate with rudimentary horn. So we report this case with a brief review literature.

A Laparoscopic Resection of A Noncommunicating Rudimentary Uterine Horn With Pelvic Endometriosis / 대한산부인과학회잡지

Noncommunicating uterine horns are rare, occasionally presenting with functional endometrial cavities, Surgical removal of the noncommunicating horn is commonly performed to prevent endometriosis and rupture of a pregnancy in these patient. We report a case of rudimentary horn with pelvic and appendicular endometriosis treated by laparoscopic resection of those lesions.

A Case of Unruptured Non - communicating Rudimentary Horn Pregnancy Progressed to the Third Trimester of Pregnancy / 대한산부인과학회잡지

The uterus with rudimentary horn occurs as a result of a lack of development during fetal life of the middle and lower parts of one of the Miillerian ducts, in which there is a failure of fusion of the two ducts, The incidence of this uterine anomaly is rare. Many cases of rudimentary uterine horn are not discovered since they do not become involved in a pregnancy, and thus remain symptomless and uncomplicated, and the diagnosis usually being made only with pregnancy with rupture. In this presentation, we describe a case of diagnosis and management of unruptured non-communicating rudimentary uterine horn pregnancy at the third trimester. The patient diagnosed by ultrasonography and MRI, was hospitalized for further evaluation and delivery under the impression of unruptured non-communicating rudimentary horn pregnancy. A living male infant weighing 1,930 gm was delivered by cesarean section at 33+l weeks due to impending preterm labor. Some articles concerned this subject were reviewed briefly to discuss relevant method of diagnosis, treatment, and clinical characteristics.

Rudimentary horn pregnancy.

A case of pregnancy in rudimentary horn is presented, and a discussion of this rare and potentially catastrophic phenomenon follows. The correct diagnosis was only made at laparotomy for acute abdominal pain when the patient was 16 weeks pregnant. Definite clinical palpation of the pregnant uterus together with ultrasonographic evidence of a viable fetus misled the diagnosis. When this condition is suspected the diagnosis may be aided by ultrasound searching of the uterus.