Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report

Rare and Occult Müllerian Deformity Diagnosed Intraoperatively During Lower Segment Caesarean Section

Uterine anomalies are the rare entities seen due to fusion defects or agenesis of Müllerian ducts in embryonic life. They are usually associated with renal defects. If non-obstructive in nature, they hardly become symptomatic until the beginning of their obstetric carrier, when they present with infertility, recurrent pregnancy loss, preterm pregnancy, rudimentary horn rupture, an ectopic baby, and numerous more negative effects. We are presenting a case report of a patient who was suffering from infertility, attempted IUI treatment five times, then stopped the treatment due to economic affordability issues, conceived spontaneously, and underwent preterm lower segment cesarean section (LSCS) due to fetal distress. During LSCS, it was found to be type 2C of the American Fertility Society (AFS) Müllerian anomaly. The post-operative period was uneventful; both mother and baby were fine, and they were discharged.

A case report of ectopic pregnancy arising in a unicornuate uterus, accompanied by the undescended tube and ovary with double inferior vena cava

RATIONALE

The incidence of a unicornuate uterus is 0.2% to 0.3% of the whole population. A unicornuate uterus is closely associated with obstetrical complications such as early miscarriages, ectopic pregnancy, and malpresentation.

PATIENT CONCERNS

A 32-year-old patient developed a rare ectopic pregnancy arising at a distal, fimbriated end of the undescended fallopian tube.

DIAGNOSES

A transvaginal ultrasound scan revealed hemoperitoneum and no gestational sac in the uterine endometrium. A laparoscopic finding showed that high up in the right abdomen, just below the liver, an ectopic mass could be seen arising at a distal, fimbriated end of the fallopian tube, which was developed adjacent to the undescended right ectopic ovary.

INTERVENTIONS

After laparoscopic removal of the right salpinx, we removed it with a bag.

OUTCOMES

One day after the operation, she was discharged without problems. Postoperative hysterosalpingography showed the unicornuate uterus with patent left and some right salpinx. Magnetic resonance imaging revealed a unicornuate uterus, right ovary at the right inferior hepatic area, a bilateral normal kidney, and double inferior vena cava.

LESSONS

This is the first reported case of its type. It demonstrated that ectopic pregnancy may occur in the upper abdomen, not in the pelvic cavity, in uterine anomaly, and double inferior vena cava; hence, we must thoroughly check the whole abdominal cavity. Additional imaging tests are needed after treatment to see if there are any abnormalities.

Variations in clinical presentation of unicornuate uterus with non-communicating rudimentary horn (class IIB of the American Fertility Society classification)

OBJECTIVE

The unicornuate uterus is a rare uterine malformation (2.4-13.7% of all uterine malformations (Engmann et al., 2004)) which usually features a rudimentary accessory horn in more than 75% of the cases. Pregnancy in the rudimentary horn is rare, but the complications attached to such pregnancies could be defined as the first clinical manifestation of rudimentary horn.

CASE REPORTS

We hereby describe five cases of unicornuate uterus with rudimentary horn (UUWRH), each one with a different clinical presentation and without any correct preoperative diagnosis, and henceforth reflect on the practical aspects learnt about the differential diagnosis and management of this rare malformation.

CONCLUSION

Our experience with UUWRH is that perhaps asymptomatic cases are not as rare as reported in medical literature. We highlight the need for a greater awareness of the differential diagnosis of genital malformations and accurate in the exact subtype and their correct treatment.

[Rudimentary horn pregnancy diagnostic: difficulties and therapeutic management]

The occurrence of rudimentary horn pregnancy is an extremely rare and potentially serious obstetric entity, threatening maternal and fetal outcome. The authors report five cases of rudimentary horn pregnancy, the difficulties in making a proper diagnosis and the therapeutic management of this pathological entity, stressing the importance of transvaginal ultrasound, of pelvic MRI and laparoscopy in the early diagnosis of this type of uterine malformation.

Rudimentary horn pregnancy in the first trimester; importance of ultrasound and clinical suspicion in early diagnosis: A case report

We aimed to present 7-8 weeks rudimentary horn pregnancy detected preoperatively. A 37-year-old woman, gravida 3, para 2, at 7-8 weeks’ gestation referred to our clinic with a complaint of abdominal pain. The patient was primarily infertile, and she had unicornuate uterus detected during infertility investigation. Due to abnormal ultrasonographic image, rudimentary horn pregnancy was considered. Accurate diagnosis was made by laparoscopy, and rudimentary horn excision was performed. Prerupture diagnosis is very difficult in rudimentary horn pregnancies. The key role in preoperative diagnosis is suspicion. Ultrasonographic examination and clinical suspicion are sufficient in most cases.

Laparoscopic excision of rudimentary horn pregnancy in a patient with previous caesarean section

A rudimentary uterine horn is extremely rare and often difficult to diagnose. The frequency of this pathology is approximately 1:100,000. The diagnosis is sometimes elusive even at surgery. We present a case report of pregnancy in a rudimentary horn in the patient with one caesarean and one normal vaginal delivery, and we successfully conduct a removal of the rudimentary horn pregnancy laparoscopically.

[Rupture of rudimentary horn pregnancy at the 18th week of gestation: a case report]

We report a case of pregnancy in a rudimentary horn that ruptured at 18 weeks. An emergency laparotomy was taken for acute abdomen and ruptured right rudimentary horn pregnancy was diagnosed. Excision of the rudimentary horn and ipsilateral salpingectomy were carried out. The patient's postoperative course was uneventful, and she left the hospital 6 days later.

Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging

OBJECTIVE

Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition.

METHODS

We report a case in which pregnancy in a rudimentary horn was suspected on routine sonographic examination. In the second case, sonographic examination at 11 weeks' gestation revealed a right unicornuate uterus and a noncommunicating left rudimentary horn containing a gestational sac. In both cases, MRI clearly confirmed the sonographic diagnosis, showing an empty cavity of the uterine body and a pregnant uterine horn without an endometrial communication to the uterine body.

RESULTS

Both patients underwent surgery, and the pregnant rudimentary horns were resected with no complications.

CONCLUSIONS

We suggest the following criteria for sonographic diagnosis of rudimentary horn pregnancy: (1) a pseudopattern of a asymmetrical bicornuate uterus, (2) absent visual continuity tissue surrounding the gestational sac and the uterine cervix, and (3) the presence of myometrial tissue surrounding the gestational sac. Typical hypervascularization of placenta accreta may support the diagnosis. Additionally, MRI can be used to confirm the diagnosis before an invasive procedure is undertaken.