A case report of ectopic pregnancy arising in a unicornuate uterus, accompanied by the undescended tube and ovary with double inferior vena cava

Abstract

Rationale: The incidence of a unicornuate uterus is 0.2% to 0.3% of the whole population. A unicornuate uterus is closely associated with obstetrical complications such as early miscarriages, ectopic pregnancy, and malpresentation. Patient concerns: A 32-year-old patient developed a rare ectopic pregnancy arising at a distal, fimbriated end of the undescended fallopian tube. Diagnoses: A transvaginal ultrasound scan revealed hemoperitoneum and no gestational sac in the uterine endometrium. A laparoscopic finding showed that high up in the right abdomen, just below the liver, an ectopic mass could be seen arising at a distal, fimbriated end of the fallopian tube, which was developed adjacent to the undescended right ectopic ovary. Interventions: After laparoscopic removal of the right salpinx, we removed it with a bag. Outcomes: One day after the operation, she was discharged without problems. Postoperative hysterosalpingography showed the unicornuate uterus with patent left and some right salpinx. Magnetic resonance imaging revealed a unicornuate uterus, right ovary at the right inferior hepatic area, a bilateral normal kidney, and double inferior vena cava. Lessons: This is the first reported case of its type. It demonstrated that ectopic pregnancy may occur in the upper abdomen, not in the pelvic cavity, in uterine anomaly, and double inferior vena cava; hence, we must thoroughly check the whole abdominal cavity. Additional imaging tests are needed after treatment to see if there are any abnormalities.

Diagnostic and Management of Undescended Ovary – A Preoperative Dilemma: A Case-Based Systematic Review

“…32,33 Another theory is a retarded differential growth of the urogenital ridge's specific region responsible for the formation of the ovaries and fallopian tubes. 34,35 UO may occur in patients with normal uterus. However, although the ovarian embryological development follows a different path than the uterus and fallopian tubes, the UO incidence is higher in the presence of uterine anomalies, particularly the unicornuate uterus (UU) caused by a lack of development of one Müllerian duct or by a disturbed descent to its proper location.…”

“…30,33 Due to the common embryological origin, UO may occur in conjunction with renal malformations such as agenesis, ectopic kidney, double renal pelvis and horseshoe kidneys. 14,19,20 Other rare associations reported in the literature are appendicular or colonic anomalies, 31,38 double inferior vena cava, 35 and intestinal malrotation. 11 Recently.…”

“…It also can be found to be rudimentary or of normal aspect but elongated. 2,24,30,31,35 The first option in imaging investigation is the traditional 2D ultrasound scan, which allows the detection of uterine and renal malformations and may even find a maldescended ovary. 8,15 3D ultrasonography or transvaginal ultrasound (in sexually active patients) may provide additional information.…”

A Case of Rupture Ectopic Pregnancy Diagnosed 10 Days After Hospital Stay In A 22-Year-Old Girl Presented With Symptoms of Anemia Without Abdominal Pain and Amenorrhea: Lessons Learned

“…Early diagnosis with amenorrhea, abdominal pain, high HCG and ultrasound finding of floating fetus of 13 Corresponding Author: Khin Phyu Pyar weeks old in peritoneal cavity was reported (Gari et al, 2020). In multiple congenital abnormality, unicornuate uterus, accompanied by the undescended tube and ovary with double inferior vena cava (Jang & Kim, 2020) Various differential diagnosis of abdominal pain in a fertile aged are urinary tract infection, appendicitis, spontaneous abortion, early pregnancy, pelvic inflammatory disease, ovarian cyst and/or torsion, and tubo-ovarian abscess. There were several reports on it.…”