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 ).