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Rupture of Noncommunicating Rudimentary Uterine Horn Pregnancy

First Department of Obstetrics and Gynaecology, Alexandra Hospital, University of Athens, Athens, Greece

Address reprint requests to: George Daskalakis, MD, University of Athens, Alexandra Hospital, First Department of Obstetrics and Gynaecology, 41 Delfon Street, 12243-Egaleo, Athens, Greece.

ABSTRACT

BACKGROUND: We present a rare case of pregnancy in a noncommunicating rudimentary horn that ruptured at 20 weeks.

CASE: A 30-year-old woman presented with a history of two spontaneous abortions. An ultrasound scan showed a bicornuate uterus, with one normal and one hypoplastic horn. Hysterosalpingography revealed a single uterine cavity with only one tube, suggesting a unicornuate uterus. Hysteroscopy and laparoscopy were recommended but declined.

She presented again 2 months later at 7 weeks’ gestation. A single intrauterine pregnancy in the hypoplastic right horn was diagnosed. A transvaginal scan showed a single cervical canal in continuity with the left uterine horn, which led to the suspicion of a pregnancy in a rudimentary horn. The option of pregnancy termination was offered. A laparoscopy was repeatedly suggested but declined. Excision of a ruptured noncommunicating rudimentary horn and ipsilateral salpingectomy were performed after an emergency laparotomy at 20 weeks because of the sudden onset of abdominal pain and signs of shock.

CONCLUSION: Although a rudimentary horn pregnancy had been suspected before the laparotomy, the patient presented as a clinical emergency. This report, like others, indicates that prompt diagnosis and immediate removal of the rudimentary horn is lifesaving.

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