腺筋症を合併した非交通性副角子宮を伴う単角子宮に対し、腹腔鏡下副角子宮摘出術を施行した一例

抄録

Introduction: Unicornuate uterus with a rudimentary uterine horn is a rare Mullerian malformation which causes dysmenorrhea, infertility and perinatal complications. We report a case of a unicornuate uterus with a non-communicating rudimentary uterine horn and with adenomyosis.

Case: A 13-year-old nulligravid woman was referred to us with dysmenorrhea and severe pelvic pain. Abdominal computed tomography and pelvic magnetic resonance imaging suggested a unicornuate uterus with a left-sided rudimentary uterine horn on the right side of the pelvis. Hematometra in the rudimentary horn, left hematosalpinx, and left renal agenesis were also observed. Laparoscopy identified prominent inflammatory adhesions, with a swollen left fallopian tube adherent to the posterior wall of the left-sided rudimentary uterine horn. Moreover, the left ovary was swollen, and an endometriotic cyst was suspected. The rudimentary horn was removed along with the ipsilateral salpinx. The left fallopian tube and an endometrioma in the left ovary were also removed, and normal ovarian tissue was preserved. Histopathologic examination of the extracted rudimentary horn showed an area of adenomyosis, and the ovarian cyst revealed an endometriotic cyst. The final diagnosis was adenomyosis in a rudimentary uterine horn and left-ovarian endometriotic cyst.

Conclusion: Laparoscopic surgery is effective for treating a non-communicating rudimentary uterine horn. A uterine obstructive malformation, such as in this case causes severe dysmenorrhea; however, due to regular menstruation, diagnosis and intervention may be delayed. In cases of severe dysmenorrhea, it is important to carefully examine the possibility of such uterine malformations.