Conservative treatment for a noncommunicating rudimentary uterine horn

Obstructive mullerian anomalies and modern laparoscopic management

STUDY OBJECTIVE

Congenital uterine anomalies are common, although the majority are asymptomatic. When an obstructed system exists, women may present with abdominal pain, or dysmenorrhea. Removal of the obstructed horn may be required in the symptomatic patient. In the past, surgical treatment necessitated a laparotomy.

DESIGN

After preoperative diagnosis and planning using magnetic resonance imaging, laparoscopic removal of the obstructed uterine horn and tube was performed. Morcellation of tissue was used to permit removal through a 15mm port.

SETTING

A central London tertiary referral teaching hospital.

PARTICIPANTS

15 women aged between 13 and 41.

INTERVENTIONS

Between 1999 and 2005, all women underwent laparoscopic removal of the obstructed uterine horn and tube.

MAIN OUTCOME MEASURES

Recovery, hospital stay, length of operation.

RESULTS

All women recovered well, with an operation time of 80 to 300 minutes and an average hospital stay of 5 days.

CONCLUSIONS

A laparoscopic approach is a safe and appropriate technique for the removal of an obstructed uterine horn.

The Presentation and Early Diagnosis of the Rudimentary Uterine Horn

OBJECTIVE

The key to successful management of the rudimentary uterine horn is early detection. This review of the literature seeks to illustrate important aspects of diagnosis and management of this anomaly.

DATA SOURCES

An English language MEDLINE search from 1966 to 2003 was performed, using the search terms "rudimentary uterine horn," "accessory horn," "uterus bicornis unicollis," "hematometra," "unicornuate or bicornuate uterus," and "mullerian anomaly." References from previously published sources were also obtained.

METHODS OF STUDY SELECTION

One hundred thirty letters, case reports, case series, and review articles featuring rudimentary uterine horn were found. Reports before 1966 were excluded because outcomes before the advent of modern diagnostic techniques were not relevant to this study.

TABULATION, INTEGRATION, AND RESULTS

Three hundred sixty-six rudimentary horn presentations (210 gynecologic and 156 obstetric) were found. Noncommunicating horns accounted for 92% of cases (95% confidence interval [CI] 88-95%, P < .001), and renal anomaly was found in 36% (95% CI 29-44%). Contrary to the American Fertility Society classification of uterine anomalies, rudimentary horns may occur without a corresponding unicornuate uterus. The mean age of presentation was similar for gynecologic and obstetric presentations (23 and 26 years, 95% CIs 21.2-24.6 and 124.9-27.3 years, respectively). Presentation in the third decade of life or later occurred in 78% of patients (95% CI 70-84%, P < .001). Sensitivity of ultrasound examination for diagnosis was 26% (95% CI 18-36%). Diagnosis before clinical symptoms occurred in 14% (95% CI 7-23%).

CONCLUSION

Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.