Case Report: Laparoscopic Management of an Ectopic Pregnancy in a Rudimentary Non-communicating Uterine Horn

Abstract

Introduction: Ectopic pregnancy in a non-communicating rudimentary uterine horn is a rare gynecological condition associated with a high risk of uterine rupture and important maternal mortality and morbidity. A surgical excision of the rudimentary horn is the standard treatment, usually performed by laparotomy in the second trimester. Methods: A 36-year-old woman, secundigravida and nulliparous, was admitted to the emergency obstetric unit with acute pelvic pain. The ultrasound found an ectopic pregnancy at 15 weeks gestational age with fetal cardiac activity. As her hemodynamic status was stable, a diagnostic laparoscopy was performed and confirmed the development of the pregnancy in a left rudimentary uterine horn. Results: We report a total laparoscopic removal of a pre-ruptured rudimentary uterine horn containing a second trimester ectopic pregnancy, using a vessel-sealer device. To our knowledge, only three other cases of successful laparoscopic treatment of second trimester rudimentary horn pregnancies have been reported in the literature. Conclusion: Laparoscopy is an efficient and safe surgical option for treating rudimentary horn second trimester pregnancy in patients with hemodynamic stability.

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery

“…Finally, 72 reports were selected for our analysis. [ 7 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 ] Most of the articles were case reports, and we found 103 cases published from January 2000 to November 2020. Two reviewers (W.I.…”

“…[ 5 10 ] To treat these cases, emergency laparotomy is performed. Apart from detecting hypovolemic shock,[ 11 12 13 14 15 16 17 ] patients frequently have abdominal pain,[ 7 11 13 14 15 16 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 ] but some reports have indicated that only 8% of rudimentary horn pregnancies (RHPs) are diagnosed before the symptoms appear. [ 44 ] Sufficient knowledge seems necessary to detect NCRHP during early obstetric screening.…”

“…Especially when detecting NCRHP in the first trimester of pregnancy, this disease can be managed by minimally invasive laparoscopic surgeries. [ 10 21 27 31 33 41 43 45 46 47 48 49 50 51 52 53 54 55 ] In some cases, laparoscopic surgeries are performed even in the second trimester of gestation. [ 10 43 ] Magnetic resonance imaging (MRI) seems to be particularly important for performing a prompt and correct diagnosis before laparoscopic treatment.…”

“…[ 10 21 27 31 33 41 43 45 46 47 48 49 50 51 52 53 54 55 ] In some cases, laparoscopic surgeries are performed even in the second trimester of gestation. [ 10 43 ] Magnetic resonance imaging (MRI) seems to be particularly important for performing a prompt and correct diagnosis before laparoscopic treatment. [ 56 ] However, a large review, which collected RHPs in the 20 th century, found that in 6.5% of all RHP cases, patients could obtain live newborn babies.…”

Розрив Рудиментарного Рогу Матки Під Час Вагітності: Опис Клінічного Випадку

“…Можливо ці заходи дозволити б своєчасно діагностувати локалізацію плідного яйця/плода та надати кваліфіковану допомогу лікарем акушер-гінекологом. Існують публікації про успішне неінвазивне виявлення вагітності у рудиментарному розі до його розриву та/або подальше хірургічне втручання навіть при появі «передвісників розриву» при стабільній гемодинаміці (Chatziioannidou et al, 2020, Bruand et al, 2020.…”