Adenomyosis and Hematometra in a Non-communicating Rudimentary Horn of a Unicornuate Uterus: A Case Report

Congenital uterine anomalies with outflow tract obstruction caused by abnormal Mullerian duct system development are rare conditions that can lead to painful pelvic emergencies such as hematometra. A unicornuate uterus with a rudimentary horn occurs in about 2.4–13% of all Müllerian duct anomalies with a prevalence of 1 in 100000 fertile women. Clinical symptoms such as dysmenorrhea, dyspareunia, and acute and chronic pelvic pain usually develop at and after menarche. Accurate diagnosis and timely surgical intervention are crucial to prevent complications such as adenomyosis, endometriosis, and infertility. A 21-year-old nulligravida Afghan female presented with severe chronic pelvic pain that worsened during menstruation and coitus. Ultrasonography and magnetic resonance imaging (MRI) revealed two separate uterine bodies. The left body was a unicornuate uterus with an endometrial lining connected to the cervix and the vaginal canal. The right body showed a functioning non-communicating rudimentary horn containing hematometra without a cervical opening. The patient underwent a hemi-hysterectomy and the rudimentary horn was removed. The histopathological findings revealed adenomyosis with cystic changes. The patient recovered after the operation and her severe pain subsided. This case underscores the importance of timely diagnosis and management of rare non-communicating functioning rudimentary horn anomalies that occur in less than 0.06% of reproductive-age women. Notably, this report adds to the limited literature on this anomaly where the rudimentary horn contained extensive adenomyosis, highlighting the potential for significant histopathological changes in such anomalies. Precise diagnosis and surgical excision are critical to prevent complications. Similar content being viewed by others Data Availability The data generated and analyzed during this study are not openly available to protect the patient’s privacy and are available from the corresponding author upon reasonable request. Code Availability Not applicable. Abbreviations - MDA : - Mullerian duct anomaly - MRI : - Magnetic resonance imaging - HSG : - Hysterosalpingography - USG : - Ultrasonography - ESHRE : - European Society of Human Reproduction and Embryology - ESGE : - European Society for Gynaecological Endoscopy - AFS : - American Fertility Society

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The authors would like to express their utmost gratitude to the patient and her family for their informed permission and consent to report this case. Author information Authors and Affiliations Contributions FWJ performed the diagnosis, clinical follow-up, and therapeutic management. FWJ and AMJ designed and drafted the manuscript, added critical revisions for intellectual content, and generated the figures. RJ, HA, and KS assisted with the clinical management and data collection. RS provided pathology analysis. All authors have read and approved the final manuscript. Corresponding authors Ethics declarations Ethics Approval This study was reviewed by the FMIC Ethical Review Committee (076-FMIC-ER-23), which determined that ethical approval was not required due to the nature of the study and patient data. A copy of the exemption letter is available upon request from the corresponding author. Consent to Participate Written informed consent was obtained from the patient and her family for the surgical procedure, the use of data for publication, and any other necessary interventions. A copy of the written consent is available upon request from the corresponding author. Consent for Publication Written informed consent was obtained from the patient and her family for the use of data for publication. A copy of the written consent is available upon request from the corresponding author. Competing Interests The authors declare no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is part of the Topical Collection on Surgery Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Wali Jebran, F., Jebran, A.M., Jalalzai, R. et al. Adenomyosis and Hematometra in a Non-communicating Rudimentary Horn of a Unicornuate Uterus: A Case Report. SN Compr. Clin. Med. 7, 57 (2025). https://doi.org/10.1007/s42399-025-01798-3 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s42399-025-01798-3