An unprecedented occult non-communicating rudimentary uterine horn treated with laparoscopic excision and preservation of both fallopian tubes: a case report and review of the literature

Abstract

Background: Müllerian duct anomalies are congenital malformations of the female genital tract and may be of various types. For decades they have been classified according to the American Society of Reproductive Medicine, which mentions unicornuate uterine malformations as the second subgroup. They result from the arrested development of one of the Müllerian ducts and appear in approximately 1/1000 women. These anomalies are usually diagnosed in the second decade of life, because they tend to remain asymptomatic until adolescence and their initial symptoms may vary. Patients present with symptoms such as dysmenorrhea, infertility, and chronic or acute abdominal pain.

Case presentation: We report on a 21-year-old Caucasian German patient who suffered from dysmenorrhea for 7 years. After a transvaginal ultrasound and magnetic resonance tomography of the pelvis was performed, the patient underwent a diagnostic hysteroscopy and operative laparoscopy, and was finally diagnosed with a Müllerian duct anomaly presenting with a non-communicating rudimentary uterine horn. The left tube arose directly in orthotopic location from the cornua of uterus, with no connection to the rudimentary uterine horn or structure.

Conclusion: The anatomic features of this case have not been reported previously and were not consistent with any existing classification. More cases are needed in order to confirm our hypothesis. Gynecologists should always consider Müllerian anomalies as an important differential diagnosis in young patients with abdominal pain.

Keywords: Laparoscopic excision; Müllerian anomalies; Rudimentary uterine horn.

Fig. 1

a Transvaginal ultrasound in the transverse plane (red arrows mark the rudimentary uterine horn, blue arrow the normal uterus and yellow arrow the bladder). b Magnetic resonance tomography (MRT) image in the sagittal plane. c MRT image in the transverse plane. d MRT image in the frontal plane

Fig. 2

a Intraoperative entrance showing the deformation of the uterus because of a rudimentary uterine horn (red arrows mark the rudimentary uterine horn, blue arrow the normal uterus. and yellow arrow the bladder). b Intraoperative image. Opening the broad ligament of the uterus and the left parametrium. c, d Preserving the “parasitic” uterus horn. e Opened uterus horn with endometrium. f Final intraoperative image after reconstruction of the uterus

Fig. 3

A1 Overview of the first block. A2 First block in detail: Irregularly arranged small glands with flat to cuboidal epithelium and uniform nuclei without mitotic activity and sparse compact stromal cells within interlacing bundles of smooth muscle cells. B1 Overview of the second block: cavity of the uterine horn. B2–B4 Second block in detail: slightly jagged and irregular luminal surface of the endometrial glands with a thin epithelium and cigar-shaped vertically oriented nuclei, sparse intraepithelial neutrophil polymorphs, and mildly pigmented hemosiderin-laden macrophages, corresponding to the macroscopic condition after bleeding