Extremely uncommon torsion and communicating ruptured rudimentary horn pregnancy at third trimester: A case report

Abstract

Torsion and rupture are life-threatening emergencies in rudimentary horn pregnancy, an extremely rare type of ectopic pregnancy. This case report aims to share the diagnosis and treatment of a patient, with torsion and ruptured horn pregnancy in a setting, with limited resources. It highlights the challenges faced and the strategies employed to ensure appropriate care. A 38-year-old woman, gravida 2, para 1, presented to the Obstetric and Gynaecology (OBGYN Department of Hiwot Fana University Hospital with a diagnosis of uterine rupture after she presented with a complaint of pushing down pain of 1 h, decreased fetal movement of 1-day duration, and with sudden and severe lower abdominal pain and distension. Conservative management was chosen, but deteriorating symptoms necessitated an emergency laparotomy, confirming a ruptured rudimentary horn pregnancy and surgically excising the horn. Ruptured rudimentary horn pregnancy with torsion is an extremely uncommon and perilous obstetric emergency that necessitates swift diagnosis and surgical intervention. For advanced primitive horn pregnancy, laparotomy combined with horn removal continues to be the gold standard of therapy. Healthcare providers can improve patient outcomes and alleviate the burden of life-threatening conditions by promoting multidisciplinary collaboration and embracing innovative, technologically advanced techniques.

Keywords: Rudimentary horn pregnancy; ectopic pregnancy; low-resource setting; rupture; torsion.

Figure 1.

(a) Right rudimentary horn pregnancy with torsion. (b) Rudimentary horn pregnancy with rupture anteriorly. (c) The cavity after extracting the fetus from the ruptured rudimentary horn. (d) 1.8 kg extracted dead fetus. (e) Uterus after performing right-side salpingo-oophorectomy.