A case of laparoscopic removal of a uterus with a rudimentary horn safely performed following preoperative 3D-reconstructed CT evaluation

Yoshiko Kurose, Kouki Samejima, Yuichiro Kizaki, Shigetaka Matsunaga, Tomonori Nagai, Yasushi Takai, Hiroyuki Seki
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2020 · vol. 36(2) , pp. 158–162 · doi:10.5180/jsgoe.36.2_158 · W3126522957
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Laparoscopic removal of a noncommunicating rudimentary horn in a unicornuate uterus was safely performed after preoperative 3D-reconstructed CT imaging guided the treatment strategy.

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Abstract

Introduction: A unicornuate uterus with a noncommunicating rudimentary horn is a rare congenital uterine malformation that causes lower abdominal pain and dysmenorrhea due to endometriosis and uterine hematoma. We encountered a case of a unicornuate uterus with a noncommunicating rudimentary horn that was safely treated through laparoscopic removal of the rudimentary horn. The treatment strategy was determined following evaluation of preoperative 3D-reconstructed computed tomography (CT) images.
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Introduction

A unicornuate uterus with a noncommunicating rudimentary horn is a rare congenital uterine malformation that causes lower abdominal pain and dysmenorrhea due to endometriosis and uterine hematoma. We encountered a case of a unicornuate uterus with a noncommunicating rudimentary horn that was safely treated through laparoscopic removal of the rudimentary horn. The treatment strategy was determined following evaluation of preoperative 3D-reconstructed computed tomography (CT) images. Case presentation: A 34-year-old patient's (gravida 1, para 1) past pregnancy history included an emergency caesarean section due to uncontrollable uterine contractions at 24 weeks of gestation. Her menstruation resumed, and at 10 months postpartum, she noted left lower abdominal pain. The patient was diagnosed with right unicornuate uterus with a noncommunicating rudimentary horn and accompanying dysmenorrhea. Surgical treatment was planned. Preoperatively, 3D-reconstructed CT images were acquired, and a defect in the left external iliac artery was confirmed. Due to the abnormal course of the left uterine artery, identification of the left ureter was delayed during the surgery. However, a careful surgery was possible due to the preoperative confirmation of the 3D-reconstructed CT, and laparoscopic removal of the left rudimentary horn and left salpingectomy were performed.

Conclusion

In recent years, minimally invasive laparoscopic surgery has been a favorable choice for the removal of rudimentary horns. It is important to confirm the course of the uterine artery and ureter before surgery. In this case, 3D-reconstructed CT was effective for establishing treatment strategies. © 2020 日本産科婦人科内視鏡学会

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Condition tags

endometriosisdysmenorrhea

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