An unprecedented occult non-communicating rudimentary uterine horn treated with laparoscopic excision and preservation of both fallopian tubes: a case report and review of the literature

Spontaneous Fistula and Abdominal Wall Endometriosis Due to Occult Existence of Unicornuate Right Uterus with Rudimentary Non-Communicating Functioning Left Horn

Accurate diagnosis of Müllerian duct anomalies (MDA) remains a clinical challenge even by direct surgical inspection. Although obstetrical complications are more frequent in women with MDA, some subtypes allow normal reproduction, further delaying the diagnosis. Unicornuate uterus with a rudimentary non-communicating functioning horn is a rare form of MDA, susceptible to many gynecologic and obstetric complications such as miscarriages, premature birth, hematosalpinx, endometriosis, and chronic pelvic pain. We present an entire case pictorial assay including preoperative imaging as well as the surgical correction of the uterine anomaly and the associated complication of an occult unicornuate right uterus with rudimentary non-communicating functioning left horn (Class U4aC0V0/ European Society of Human Reproduction and Embryology/European Society of Gastrointestinal Endoscopy Classification) and its natural evolution following a previous incomplete surgical treatment. The patient had an emergency left adnexectomy for hematosalpinx and ovarian endometrioma at her local county hospital. After five years, the patient presented with severe dysmenorrhea and abdominal endometriosis due to blocked retrograde menstruation from a rudimentary, non-communicating functioning horn. Surgical treatment with the resection of the rudimentary uterine horn, together with the abdominal wall endometriosis lesions, was carried out with good outcomes.

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.

Unicornuate Uterus with a Non-Communicating Rudimentary Horn: Challenges and Management of a Rare Pregnancy

We present a unique case of pregnancy developed in a unicornuate uterus with a non-communicating rudimentary horn, emphasizing the importance of early identification, careful management, and counseling. Our patient, a 28-year-old woman, presented with abdominal pain and premature rupture of membranes at 37 weeks of gestation. She had a history of one previous normal vaginal delivery and no significant medical or genetic factors. An emergency cesarean section was performed, and a baby boy weighing 2900 grams was delivered without complications. The uterine anomaly was identified as a unicornuate uterus with a non-communicating rudimentary horn. This case report highlights the challenges and risks associated with unicornuate pregnancies, such as fetal growth restriction and preterm labor. Timely identification, meticulous monitoring, and comprehensive counseling are crucial for optimal outcomes in such cases. Further research and larger-scale studies are needed to enhance our understanding of these rare and complex pregnancies.