Abstract
We performed hysteroscopy and laparoscopy on a 23-year-old, non-pregnant patient, diagnosed with a non-communicating rudimentary uterine horn. At the age of 18, vaginal drainage was performed for hematometra in the rudimentary horn. Irregular vaginal bleeding lasting up to one week persisted, with lower abdominal and back pain. Transvaginal sonography revealed a normal-appearing uterus on the right, but free space to the left of the visualized right uterus. Abdominal computed tomography and pelvic magnetic resonance imaging suggested hematometra and hydrosalpinx. Laparoscopy identified prominent inflammatory adhesions, with a swollen left fallopian tube adherent to the posterior wall of the left rudimentary uterine horn and rectum. A left ovary was not identified. We performed left salpingectomy and adhesiolysis, and identified the left rudimentary uterine horn. Hysteroscopy identified a narrow opening into the left rudimentary uterine horn, with drainage on the left side, beyond the cervix. We perfomed left laparoscopic rudimentary uterine horn hysterectomy and left oophorectomy. Postoperatively, the abdominal pain and irregular vaginal bleeding decreased. On outpatient follow-up, she reported that her menstrual cramps had gradually increased, and she started a painkiller two years seven months after surgery. We determined that the myometrial layer of the right unicornuate uterus had thickened, indicating likely adenomyosis on MRI. The patient is currently receiving dienogest, in addition to a painkiller, and the menstrual cramps have improved. [Adv Obstet Gynecol, 70 (2) : 113-119, 2018 (H30.5)]
