Ruptured Ectopic Pregnancy in an Accessory Horn of Uterus: A Case Report

Abstract

A unicornuate uterus with an accessory horn is one of the rarest congenital uterine anomalies; hence, the possibility of ectopic pregnancy in the accessory uterine horn is highly uncommon. It poses a significant risk to maternal life, as it is difficult to identify before surgery due to the severe hemoperitoneum in the event of rupture of the ectopic pregnancy. We report a case of a 20-year-old primigravida who presented to the emergency department of Civil Hospital Karachi, with sudden onset of generalized abdominal pain, vomiting, and dizziness at 17 weeks of gestation. Emergency ultrasonography of the abdomen showed extensive echogenic fluid, which was considerably obscuring the view. An empty uterus was seen with a complex cystic mass on its right side separate from the ovary. A ruptured ectopic pregnancy was suspected, and hence, the patient was immediately shifted to the operating room. Emergency laparotomy was done which then showed ruptured ectopic pregnancy with a viable fetus in a right-sided rudimentary horn of the uterus. The horn was excised. The patient recovered well, and the postoperative course was uneventful.

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

“…Emergency open surgery with multiple blood transfusions is the only option. 14,15 But with advent of better diagnostics, and more women being diagnosed in first trimester scans, medical line of management with surgical removal being done on a later date has become possible. 5 There are no fixed guidelines to manage such ectopics, but like management of other ectopic pregnancy, in early hemodynamically stable pregnancy, intrauterine or intramuscular methotrexate, or intrauterine KCL can be injected.…”

“…Earlier days, or in places where access to health care is difficult, when diagnosis is a problem, women often come with rupture of rudimentary horn with unstable hemodynamic condition. Emergency open surgery with multiple blood transfusions is the only option 14,15 . But with advent of better diagnostics, and more women being diagnosed in first trimester scans, medical line of management with surgical removal being done on a later date has become possible 5 .…”

Does Delay in the Diagnosis of Rudimentary Horn Pregnancy in Patients With Unicornuate Uteri Impact Treatment Outcome?

“…The top 10 research priorities for female and unexplained infertility were identified during a consensus development meeting involving 41 participants from 11 countries (Table 1). 1 Anjila Roumia, MD, 1 Samantha Yee, Ph.D, 2 Ari Y. Baratz, MD, 3 Karen B. Glass, MD, 2 Prati Sharma, MD, 2 Clifford Lawrence Librach, MD 2 1 CReATe fertility centre, Toronto, ON, Canada; 2 CReATe Fertility Centre, Toronto, ON, Canada; 3 University of Toronto, Toronto, ON, Canada.…”

“…A rare case of term viable secondary abdominal pregnancy following rupture of a rudimentary horn: a case report. Journal of medical case reports, 3 (1)…”

“…Unruptured postdated pregnancy with a live fetus in a noncommunicating rudimentary horn. Indian journal of medical sciences, 61(1), 23-27. 24.…”