A case of unicornuate uterus with a non-communicating rudimentary uterine horn, with adenomyosis, managed with laparoscopic surgery

Maho Shimizu, Keitaro Yamanaka, Keiichi Washio, Ryōsuke Takahashi, Satoshi Nagamata, Yuka Murata, Kaho Suzuki, Yoshito Terai
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2020 · vol. 36(2) , pp. 163–169 · doi:10.5180/jsgoe.36.2_163 · W3129073664
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This case report describes a laparoscopic surgical management of a rare unicornuate uterus with a non-communicating rudimentary horn and adenomyosis.

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Abstract

Introduction: Unicornuate uterus with a rudimentary uterine horn is a rare Mullerian malformation which causes dysmenorrhea, infertility and perinatal complications. We report a case of a unicornuate uterus with a non-communicating rudimentary uterine horn and with adenomyosis.
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Introduction

Unicornuate uterus with a rudimentary uterine horn is a rare Mullerian malformation which causes dysmenorrhea, infertility and perinatal complications. We report a case of a unicornuate uterus with a non-communicating rudimentary uterine horn and with adenomyosis. Case: A 13-year-old nulligravid woman was referred to us with dysmenorrhea and severe pelvic pain. Abdominal computed tomography and pelvic magnetic resonance imaging suggested a unicornuate uterus with a left-sided rudimentary uterine horn on the right side of the pelvis. Hematometra in the rudimentary horn, left hematosalpinx, and left renal agenesis were also observed. Laparoscopy identified prominent inflammatory adhesions, with a swollen left fallopian tube adherent to the posterior wall of the left-sided rudimentary uterine horn. Moreover, the left ovary was swollen, and an endometriotic cyst was suspected. The rudimentary horn was removed along with the ipsilateral salpinx. The left fallopian tube and an endometrioma in the left ovary were also removed, and normal ovarian tissue was preserved. Histopathologic examination of the extracted rudimentary horn showed an area of adenomyosis, and the ovarian cyst revealed an endometriotic cyst. The final diagnosis was adenomyosis in a rudimentary uterine horn and left-ovarian endometriotic cyst.

Conclusion

Laparoscopic surgery is effective for treating a non-communicating rudimentary uterine horn. A uterine obstructive malformation, such as in this case causes severe dysmenorrhea; however, due to regular menstruation, diagnosis and intervention may be delayed. In cases of severe dysmenorrhea, it is important to carefully examine the possibility of such uterine malformations. © 2020 日本産科婦人科内視鏡学会

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Condition tags

adenomyosisdysmenorrheainfertility

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