術前の3D再構築CT評価により安全に手術を施行し得た腹腔鏡下副角子宮切除術の1例

抄録

Introduction: A unicornuate uterus with a noncommunicating rudimentary horn is a rare congenital uterine malformation that causes lower abdominal pain and dysmenorrhea due to endometriosis and uterine hematoma. We encountered a case of a unicornuate uterus with a noncommunicating rudimentary horn that was safely treated through laparoscopic removal of the rudimentary horn. The treatment strategy was determined following evaluation of preoperative 3D-reconstructed computed tomography (CT) images.

Case presentation: A 34-year-old patient's (gravida 1, para 1) past pregnancy history included an emergency caesarean section due to uncontrollable uterine contractions at 24 weeks of gestation. Her menstruation resumed, and at 10 months postpartum, she noted left lower abdominal pain. The patient was diagnosed with right unicornuate uterus with a noncommunicating rudimentary horn and accompanying dysmenorrhea. Surgical treatment was planned. Preoperatively, 3D-reconstructed CT images were acquired, and a defect in the left external iliac artery was confirmed. Due to the abnormal course of the left uterine artery, identification of the left ureter was delayed during the surgery. However, a careful surgery was possible due to the preoperative confirmation of the 3D-reconstructed CT, and laparoscopic removal of the left rudimentary horn and left salpingectomy were performed.

Conclusion: In recent years, minimally invasive laparoscopic surgery has been a favorable choice for the removal of rudimentary horns. It is important to confirm the course of the uterine artery and ureter before surgery. In this case, 3D-reconstructed CT was effective for establishing treatment strategies.