Surgical management of twin pregnancy in rudimentary uterine horn

 

Objective: We report a case of surgical management of twin pregnancy in a rudimentary horn suspected on ultrasound examination.

Case report:

Mrs M.S, aged 25, was Gravida 3 Para 1, with a history of preterm birth at 34 weeks by caesarean section for breach presentation and spontaneous miscarriage at 8 week of gestation (WG).

The patient was referred for ectopic pregnancy suspicion at 9 WG. This pregnancy was induced by clomiphene citrate. General examination found a stable hemodynamic state. Speculum examination showed a single cervix. The ultrasound examination showed two hemi-uteri, one right that appears empty and bulkier and the other left, smaller and seat of a twin pregnancy with two living embryo. There was no effusion in the peritoneum.

Twin pregnancy on rudimentary horn was suspected. Diagnostic laparoscopy was performed and showed a pseudo-unicorn uterus with a left rudimentary non-communicating horn that was hyperemic. We performed left hemi-hysterectomy. Post-operative follow-up was uncomplicated. Abdominal ultrasound showed an ectopic left kidney.

Discussion:

Pseudo-unicorn uterus with rudimentary uterine horn is a major uterine malformation according to Musset's classification. The frequency of pregnancy in a rudimentary uterine horn is estimated at one in every 150,000 pregnancies. Twin pregnancy on rudimentary horn is still much rarer.

Conclusion:

The discovery of a unicorn uterus justifies the search by ultrasound and / or laparoscopy of a rudimentary uterus likely to be the subsequent seat of an ectopic pregnancy. In such a situation, resection of this rudimentary horn is necessary to prevent rupture, which may be life-threatening.