Unveiling the Hidden Horn: A Rare Case of Rudimentary Uterine Horn with Endometriotic Diseases

Background: A rudimentary uterine horn is a rare congenital anomaly that results from the abnormal development of one Mllerian duct, while the other duct remains underdeveloped.This condition is often associated with a unicornuate uterus and may lead to severe complications, such as endometriosis, due to retrograde menstruation.The diagnosis of this anomaly is challenging due to non-specific symptoms and high misdiagnosis rates. Case summary:We present the case of a 45-year-old woman who experienced progressive dysmenorrhea for 10 years and prolonged menstrual periods for 3 months.Imaging studies, including ultrasound and MRI, suggested a double uterus with multiple fibroids and potential hydrosalpinx.During laparoscopic surgery, the patient was found to have a rudimentary uterine horn with a small connection to the unicornuate uterus, right ovarian cysts, severe pelvic adhesions, and endometriosis.The surgical procedures included the removal of the rudimentary horn, right ovarian cystectomy, and excision of fibroids from both the left and right uteri.Postoperative pathology confirmed leiomyoma and adenomyosis.The patient is currently under follow-up with normal ultrasound and laboratory findings. Conclusion:This case highlights the importance of early recognition and accurate diagnosis of rudimentary uterine horn, which is often misdiagnosed due to atypical presentations.A combination of imaging techniques, clinical evaluation, and surgical exploration is critical for proper management.Early intervention can help alleviate symptoms, prevent complications like endometriosis, and improve patients' quality of life.