Laparoscopic Management of Rudimentary Uterine Horns in Patients with Unicornuate Uterus: A Systematic Review

Abstract

Introduction: Unicornuate uterus is a rare Müllerian anomaly. Its potential association with a rudimentary uterine horn can cause a diagnostic delay. The most common consequences are pelvic pain, hematometra and endometriosis. Diagnosis of a unicornuate uterus is usually done by imaging combining ultrasound (US) and Magnetic Resonance Imaging (MRI). The aim of this systematic review is to assess the role of laparoscopic approach in the management of this rare condition. Methods: A comprehensive search was performed in PubMed, EMBASE, SCOPUS and Web of Science databases prior to 1 may, 2022 according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement (PRISMA). The inclusion criteria were: cases of rudimentary horn managed through laparoscopy only; laparoscopic treatment of communicating or non-communicating uterine horn. Results: The search strategy identified 45 articles. After this first screening, 37 studies were evaluated. The full text of remaining articles was examined. 35 studies were finally included in this article. All included studies were case reports, due to the rarity of this condition. Rudimentary horns were non-communicating in all cases. Conclusion: The laparoscopic removal of a rudimentary uterine horn could be considered a feasible therapeutic option. An accurate preoperative evaluation is mandatory to assess anatomic variants and to select the optimal and tailored surgical approach, based also on the symptoms complained by the patient.

Diverse ultrasound image features of unilateral genital tract obstruction with ipsilateral renal anomaly syndrome on genitourinary system segmental sequential ultrasound screening and the accuracy of ultrasonic diagnosis

“…We agree with the hypothesis that at about the sixth week of embryonic development, the development of the ipsilateral vagina stops when the caudal development of the unilateral mesonephric tube stops, resulting in the failure of the development of ureteral buds and kidneys on the ipsilateral side, which in turn leads to abnormal development of the uterus ( 20 ). Unilateral outlet obstruction of the genital tract leads to menstrual reflux, and long-term persistent menstrual reflux is closely related to the occurrence and development of pelvic endometriosis and pelvic adhesion ( 8 , 21 , 22 ).…”

Case report: Rudimentary uterine horn with ovarian endometriosis manifested as pelvic ectopic kidney

“…The unicornuate uterus is usually associated with urinary tract abnormalities because the urinary tract, gastrointestinal tract, and genitalia drain into a common chamber until the 5th week of embryonic development ( 5 , 6 ). Statistically, the incidence of unicornuate uterus with renal hypoplasia or ectopic kidney is 15%, of which 40% are congenital renal agenesis on the side of the rudimentary horn ( 5 , 7 ). In the present case, a rare unicornuate uterus with congenital renal agenesis on the rudimentary horn side was reported.…”

“…Another theory is coelomic metaplasia which refers to the original celomic membrane undergoing metaplasia forming typical endometrial glands and stroma. Moreover, the theory of lymphatic and vascular metastasis suggests that the endometrium acts like neoplastic cells, invading the blood and lymphatic vessels and spreading elsewhere ( 5 , 10 , 11 ).…”

“…The standard treatment option for the rudimentary uterine horn is surgical resection of the rudimentary horn and fallopian tube. However, confirmation of the diagnosis by adequate preoperative examination and intraoperative laparoscopic exploration is essential ( 5 , 16 ). In the present case, despite an intraoperative consultation with the gynecologist, the ovary and fallopian tubes were not identified due to tissue adhesion, leading to an incorrect diagnosis and surgery.…”