Case report:
23 years old, married woman, primigravida, walked into the outpatient
clinic with right sided lower abdominal pain for a day. No other
positive complaints. She had missed her periods that month. Per abdomen
was soft, with mild tenderness on the right lower abdomen. Per speculum
examination showed a single normal looking cervix, with no discharge or
bleeding. Per vaginal examination, cervix was closed, with mobile
uterus, portio-sliding pain absent and no palpable vaginal septum. A 2D
ultrasound was done, which showed an enlarged uterus with thickened
endometrium. Extrauterine pregnancy was seen with live embryo of 6 weeks
and 4 days, which was completely surrounded by a thick wall. An ectopic
pregnancy was suspected, but the thick wall did not look like a
fallopian tube. Hence, in 3D vaginal ultrasound, two uterine horns could
be separated with both the horns connected only with a small strip of
tissue. There was no endometrial connection of the pregnant horn with
the cervix, or the main horn (Figure 1 ). Both ovaries appeared
normal. There was no free fluid in the pouch of Douglas. We were
expecting her Bhcg to be of normal pregnancy range which was found to be
47371IU/l.
After thorough counselling of the couple, and pre-anaesthetic checkup
and consent, she was posted for explorative laparoscopy and removal of
the ectopic pregnancy. After placing all the ports, thorough examination
of the abdomen was done, which showed two horns of the uterus, with a
non-communicating horn being vascular, two fallopian tubes arising from
each horn, with two normal ovaries. Both the horns were connected with a
fibrous band. A schematic diagram illustrates a better understanding of
the condition (Figure 2 ). We were dealing with an unruptured
live ectopic pregnancy of rudimentary non-communicating horn of
unicornuate uterus. No free fluid present Rest of the abdomen looked
normal (Figure 3 ).
The fibrous band, along with the base of the pregnant horn cauterised
using bipolar, and cut with scissors laparoscopically. Ipsilateral
salpingectomy was done. Both the horn and the ipsilateral tube were
removed using endobag (Video 1 ). There was no haemorrhage
during surgery. Patient was discharged the next day with advice to
follow up with renal ultrasound. Macroscopically, the uterine horn was
about size of 4*4cm, which was dissected. It had a myometrium, and the
products of conception well implanted into the endometrium. Histology
revealed the ectopic pregnancy in the rudimentary horn, and not in a
fallopian tube (Figure 4 A,B ).