Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review

Abstract

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.

Keywords: Country; gestational age; laparoscopic surgery; noncommunicating rudimentary horn pregnancy; uterine rupture.

Figure 1

Clinical images. (a) The dominant left uterine horn. (b) Gestational sac with a yolk sac was detected near the right adnexa. (c-e) The thick myometrium. (f-g) Magnetic resonance imaging images. Coronal view (f). Axial view (g). (h-l) Laparoscopic surgery images. The process of resecting the fibromuscular band tissue between the left hemi-uterus (arrow) and the right rudimentary horn (arrowhead) (h-j). The resected specimen was retrieved from the small hole of the vaginal wall (k). (l) The dominant uterine horn and normal bilateral ovaries. (m) Gestational sac-like tissue in the resected specimen

Figure 2

Country-specific differences. Developed: Developed countries, Others: Countries other than developed countries, T: Total, Shock: Hypovolemic shock, Right-sided: Right-sided noncommunicating rudimentary horn pregnancy, Intrauterine fetus: Diagnosis of suspected intrauterine fetus, Termination: Pregnancy termination, Laparoscopy: Laparoscopic surgery. *P < 0.05, **P < 0.01

Figure 3

Differences between three trimesters. 1^st: First trimester of gestation, 2^nd: Second trimester of gestation, 3^rd: Third trimester of gestation, T: Total, Shock: Hypovolemic shock, Right-sided: Right-sided noncommunicating rudimentary horn pregnancy, Intrauterine fetus: Diagnosis of suspected intrauterine fetus, Termination: Pregnancy termination, Laparoscopy: Laparoscopic surgery *P < 0.05, **P < 0.01