Laparoscopic Management of Rudimentary Horn Pregnancy: A Case Report and Review of the Literature

Abstract

Abstract

Background: Rudimentary horn pregnancy is a rare but important cause of gynecologic morbidity and mortality. As the available literature is limited, the optimal surgical approach and techniques have not been defined clearly. Case: This report describes a case of a multiparous woman who presented with painless vaginal spotting. Her history included a previous preterm vaginal birth at 35 weeks' gestation and a subsequent cesarean section for breech presentation. At the current presentation, she was otherwise asymptomatic and had no abnormal examination findings. A transvaginal ultrasound revealed a 3-cm cystic structure in the right adnexa with a thick echogenic wall containing a yolk sac, and a left unicornuate uterus. Diagnostic laparoscopy revealed a unicornuate uterus with a bulging noncommunicating right rudimentary horn measuring 4 cm. Excision of the rudimentary horn and an ipsilateral salpingectomy were performed. Upon excision, it was confirmed that there was no communication between the rudimentary horn and the endometrial cavity. Results: Postoperatively, the patient had an unremarkable recovery. A literature review revealed 19 additional cases of laparoscopic management of rudimentary horn pregnancy. Surgical techniques and instruments, retrieval methods, and adjunctive pharmaceutical therapies are compared this report. Conclusions: Conventionally, management of rudimentary horn pregnancy has been via laparotomy, but laparoscopy has recently been shown to be as efficacious with lower surgical morbidity. Laparoscopic management of rudimentary horn pregnancy is an appropriate approach for first-trimester rudimentary horn pregnancies when expertise and equipment are available and patients are hemodynamically stable. (J GYNECOL SURG 32:293)