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10.320GYN Laparoscopic Excision of a Rudimentary Uterine Horn with an Intrauterine...

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Uploaded on Sep 27, 2010

TITLE: Laparoscopic Excision of a Rudimentary Uterine Horn with an Intrauterine Pregnancy at 9-6/7 Weeks' Gestation

Pregnancy in a rudimentary uterine horn is a rare and potentially lethal condition. It carries risks of uterine rupture, hemorrhage, and maternal death.

In 2005, a 24-year-old lady was diagnosed by imaging studies and laparoscopy to have an absent right kidney, a bicornuate uterus with a right rudimentary uterine horn, and a single cervix, a transverse vaginal septum with hematocolpos, and endometriosis secondary to reflux menstruation. The transverse vaginal septum was excised, and the surgeon observed a single cervix. Oral contraceptives were prescribed as complementary treatment for the endometriosis and associated dysmenorrhea.

In 2009, MRI confirmed resolution of hematocolpos and revealed a right cervix connected to the rudimentary right uterine horn and covered by a partial longitudinal vaginal septum. The patient had a contraception failure and presented in 2010 at 96/7 weeks' gestation. By ultrasound and subsequent MRI, the pregnancy was in the right uterine horn, and the corpus luteum was on the left ovary. The myometrium was thinned to 2-mm to 3-mm atop the gestational sac.

Using the Harmonic ACE, laparoscopic excision of the right fallopian tube and right rudimentary horn with intact pregnancy was performed in 125 minutes with estimated blood loss of 75mL. The patient was discharged home the same day.

This case illustrates the risk for uterine rupture when pregnancy forms in a rudimentary horn, presumed transperitoneal migration of an ovum that was captured by the opposite fallopian tube, and the surgical management of the intact pregnancy by laparoscopic supracervical excision of the rudimentary horn.

Abs# 10.320
Authors: A. Karim Nawfal, MD, Charla M. Blacker, MD, Ronald C. Strickler, MD, David Eisenstein, MD

Department of Gynecology, Obstetrics, and Women's Health, Henry Ford Hospital, Detroit, Michigan, USA

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