帝王切開術後に月経困難症状を呈した非交通性副角子宮の一例

抄録

　A unicornuate uterus with a rudimentary horn is an uncommon anomaly that affects 0.1% of all women. Here, we present the case of a 29-year-old woman who underwent laparoscopic surgery for a rudimentary uterine horn.

　At 28 years of age, she became pregnant with her first child. The pregnancy resulted in intrauterine fetal death at 23 weeks of gestation.Initially, a uterine malformation was not diagnosed, but no apparent connection was observed between the uterus and vagina, leading to a suspicion of noncommunicating rudimentary horn pregnancy. She underwent a cesarean section because vaginal delivery was deemed impossible.

　Postoperatively, the dysmenorrhea worsened. Magnetic resonance imaging (MRI) revealed a cesarean scar defect and a retained hematoma in the fallopian tube. She was referred to our hospital six months after her cesarean section. Laparoscopic resection of the rudimentary horn was performed to ease her symptoms and increase her chances of future pregnancy. No apparent connections were observed between the contralateral horns. Her dysmenorrhea subsided after the laparoscopic surgery. An MRI performed two months after surgery revealed no rudimentary horn resection scar defects. She conceived spontaneously 16 months after the laparoscopic surgery and delivered via cesarean section. When a cesarean section is performed for a rudimentary horn pregnancy, early removal of the rudimentary horn is desirable to prevent recurrence. During the waiting period or when the rudimentary horn is preserved, postoperative dysmenorrhea may occur. The evaluation of surgical scarring using MRI after rudimentary horn resection is useful for managing patients who wish to conceive.