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. (C) 2002 by The American
College of Obstetricians and Gynecologists
