Sub-Splenic Ectopic Pregnancy Adjacent to a Communicating Rudimentary Uterine Horn

Objective. Determine the appropriate diagnostic tool in the surgical management of ectopic pregnancy located on the left upper quadrant and subsplenic. Background. Müllerian agenesis is a female developmental anomaly that remains one of the most interesting disorders encountered by contemporary obstetricians and gynecologists. While the majority of women with müllerian duct anomalies have little problem conceiving, they have higher associated rates of spontaneous abortion, premature delivery, and abnormal fetal lie and dystocia at delivery. Methods. A rare case of a tubal pregnancy in a displaced communicating rudimentary uterine horn is discussed. Image diagnosis and pathological examination of the uterus and left pericolic gutter mass revealed that this uterine malformation was a unicornuate hemiuterus with a communicating, non-cavitary right rudimentary horn and displaced left communicating tube with ovarian streak. Results. A 4 x 5 cm mass was identified in the left pericolic gutter about 5 -7 cm from the spleen appearing to be remnants of an ovarian streak. Histopatholgic examination confirmed fragments of chorionic villi with hemorrhage and segments of a fallopian tube, consistent with an ectopic pregnancy. Biopsies taken showed the presence of a corpus luteum. Conclusion. In our case, the abnormally high position of the tubal ectopic pregnancy meant that it was outside the transvaginal ultrasound field, but there was evidence of pelvic collection. Laparoscopy, in these exceptional cases, is the most accurate diagnostic tool that carries significant advantages with effective surgical management, thereby avoiding Laparotomy with superior visualization of the abdominal cavity.