The Unicornuate Uterus with an Occult Adenomyotic Rudimentary Horn

We report 2 case of an atypical variant of unicornuate uterus in 2 adolescent patients with severe dysmenorrhea. Pelvic ultrasonography and magnetic resonance imaging identified a normal uterine contour. On the right side within the uterine fundus, a nodule was detected with a small hypoechogenic content. At laparoscopy the uterus and adnexae appeared to be normal. No endometriotic lesions were identified. Hysteroscopy identified a single regular cervical canal and a uterine cavity resembling that of a left unicornuate uterus, with a single regular left tubal ostium. Complete resection of the right uterine nodule along with an ipsilateral salpingectomy was performed. The nodule contained a small endometrial cavity and hematometra. Histologic study showed a cavitated adenomyotic uterine rudiment. The patients were discharged on the second postoperative day. No intraoperative or postoperative complications or recurrence of pelvic pain occurred.     

Intrauterine fallopian tube incarceration: an uncommon complication of termination of pregnancy by vacuum aspiration

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.     

An incidental finding of unicornuate uterus with unilateral ovarian agenesis during cesarean delivery

Introduction The association of müllerian anomalies with concomitant gonadal development abnormalities is very rare. The literature revealed only a few cases of unicornuate uterus with unilateral ovarian agenesis. The pathophysiology of this rare combination is not clear. Case report A 31-year-old primiparous woman at 38 weeks’ gestation admitted to our labor room due to painful uterine contractions. An emergency cesarean section was performed and a 3,100-g healthy male infant was delivered. At cesarean delivery, she was found to have unicornuate uterus with no evidence of a rudimentary horn and the absence of a left (unilateral) ovary. The right fallopian tube, round ligament, and ovary were all normal. The left fallopian tube, round ligament, and ovary were all absent. Intraabdominal exploration, intravenous pyelography, postoperative abdominal and transvaginal ultrasonography were failed to reveal additional gynecologic, renal and urinary tract anomalies. Conclusion To our best knowledge this case is unique since the incidental diagnosis of unicornuate uterus with ipsilateral ovary was made during cesarean delivery.     

Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report.

OBJECTIVE: To report a case of tubal pregnancy in a unicornuate uterus with rudimentary horn on the side of the rudiment and its pathology. DESIGN: Case report. SETTING: University hospital. PATIENT: An 18-year-old woman, primigravida, with tubal pregnancy. INTERVENTION(S): Systemic administration of methotrexate, salpingectomy by laparotomy, and laparoscopic surgery for resection of rudimentary horn. MAIN OUTCOME MEASURE(S): Emergent laparotomy revealed that the intraperitoneal hemorrhage was caused by the rupture of the tubal pregnancy on the same side as the rudimentary horn of the unicornuate uterus. A corpus luteum was found at the ipsilateral ovary of the rudimentary horn. RESULT(S): Image diagnosis and pathological examination of the rudimentary horn revealed that this uterine malformation was a unicornuate uterus with a noncommunicated, noncavitary rudimentary horn, corresponding to class IIc of the American Fertility Society classification of müllerian anomalies. CONCLUSION(S): This is the first report of a tubal pregnancy on the side of the noncommunicating rudimentary horn with the ipsilateral ovary carrying a corpus luteum in a unicornuate uterus.     

Microsurgical fallopian tube transposition with subsequent term pregnancy

A case is described in which a patient with a non-communicating left unicornuate uterus and surgically absent left tube and ovary delivered at term after a microsurgical anastomosis of the right fallopian tube and left cornua. Pregnancy rates with this type of procedure have been reported to be comparable to ipsilateral tubal anastomosis. Tubal transposition should be considered as an alternative option to IVF-ET in selected patients.     

Torsion of Fallopian Tube Remnant Associated with Noncommunicating Rudimentary Horn in Adolescent Girl with Unicornuate Uterus

BackgroundThe prevalence of müllerian anomalies may be as high as 7% in the general population, yet there is scant published literature on adnexal torsion occurring in these patients.CaseA 14-year-old female presented with right lower quadrant pain. Pelvic ultrasonography demonstrated a 2-cm simple right adnexal cyst. Diagnostic laparoscopy revealed a unicornuate uterus with a normal left uterine horn and fallopian tube but atretic and cordlike müllerian structures on the right side. Torsion of the right tubal remnant and two paratubal cysts were noted and the structures were then excised.Summary and ConclusionAgenesis, hypoplasia, or maldevelopment of müllerian structures may predispose patients to an increased risk of adnexal torsion secondary to looser ligamentous attachments and consequent lack of fixation to the pelvic sidewall.     

Laparoscopic approach to an uncommon adnexal neoplasm associated with infertility: serous cystadenofibroma of the fallopian tube

A rare case of serous cystadenofibroma of the fallopian tube was discovered during evaluation for in vitro fertilization-embryo transfer. Bilateral tubal occlusion was noted on hysterosalpingogram, and a right adnexal cyst, initially thought to be of ovarian origin, was identified by office transvaginal sonography. Laparoscopy revealed a 5.5-cm, fluid-filled mass involving the distal aspect of the right fallopian tube. Both ovaries and uterine exterior appeared grossly normal. The cyst was decompressed and removed intact without incident through a 5-mm laparoscopic cannula. The mass showed histologic features consistent with benign serous cystadenofibroma. The patient had an uncomplicated postoperative convalescence and continued to do well 3 months after surgery.     

Hernia uterine inguinale: an uncommon cause of pelvic pain in the adult female patient

Hernia uterine inguinale is a rare condition often presenting within the first few years of life as an asymptomatic palpable mass in the inguinal/groin area. This type of hernia contains uterine tissue and may contain oviducts, ovaries, and rarely the bladder. We report a case of a woman with a history of pelvic pain, found to have a rudimentary uterine horn herniating through the internal inguinal ring. A 24-year-old woman presented with noncyclic pelvic pain and irregular menses. Imaging revealed a solid 6- × 2-cm mass posterolateral to the ascending colon at the level of the pelvic brim in addition to absent right kidney and suspected unicornuate uterus. Laparoscopy with excision of the pelvic mass and appendectomy was performed. Surgical findings revealed a right rudimentary uterine horn herniating through the internal inguinal ring, attached to an elongated ovary/and an oviduct tightly tethered to the pelvic side wall. The result of pathologic study was consistent with rudimentary uterine horn, ovary with multiple cortical cysts, normal oviduct, and normal appendix. Hernia uterine inguinale is a rare condition and an even more uncommon cause of pelvic pain, instead presenting as an asymptomatic palpable groin mass early in life. This has been reported most commonly in the literature as both persistent müllerian duct syndrome and male pseudohermaphroditism. It is most often seen in a phenotypically normal male infant having both testes and uterine tissue present. Few cases have been documented to occur in the female sex, the adult patient, or as a cause of pelvic pain. Abdominal and pelvic imaging is useful in the diagnosis of this condition because it may aid in identifying patients with coexisting mullerian malformations. This subset may be at higher risk for hernia uterine inguinale, and, if presenting with complaints of pain or inguinal mass, it should likewise be considered in the differential diagnosis.     

Ovarian malposition – Mullerian anomalies revisited

A chronic pelvic pain case is presented with right unicornuate uterus, non-communicating left uterus, missing left fallopian tube, left uterosacral ligament lateral insertion to the periosteum of iliac bone, and ectopic left ovary, located under the sigmoid colon. Neither MRI, nor Laparoscopic evaluation may not be a sufficient tool alone to diagnose these rare cases.     

Laparoscopic management of pregnancy in a patient with uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis

Pregnancy in a rudimentary uterine horn is a rare and potentially lethal condition. The highest risk of rupture is reported to be during the late first and second trimester. The risk of rupture correlates with the thickness of the myometrium surrounding the fetal pole. In 2005, a 20-year-old woman was incompletely diagnosed by imaging studies and laparoscopy to have an absent right kidney, a bicornate uterus with a right rudimentary uterine horn and a single cervix, a transverse vaginal septum with hematocolpos, and endometriosis caused by reflux menstruation. The transverse vaginal septum was excised, and the surgeon observed a single cervix. Oral contraceptives were prescribed as complementary treatment for the endometriosis and associated dysmenorrhea. In 2009, magnetic resonance imaging confirmed resolution of hematocolpos and revealed a right cervix connected to the right horn of a uterus didelphys and covered by a partial longitudinal vaginal septum. The patient had a contraception failure and presented in 2010 at 9(6/7) weeks' gestation. By ultrasonography and subsequent magnetic resonance imaging, the pregnancy was in the right uterus and the corpus luteum was on the left ovary. The myometrium was thinned to 2 to 3 mm atop the gestational sac. Using the Harmonic ACE, laparoscopic excision of the right fallopian tube and a supracervical right hysterectomy with an intact pregnancy was performed. This case supports the Acién hypothesis that the vagina forms from both Müllerian and Wolffian duct elements, and it illustrates the risk for uterine rupture when pregnancy forms in a rudimentary structure; presumed transperitoneal migration of an ovum that was captured by the opposite fallopian tube; and?surgical management of the in situ pregnancy by laparoscopic supracervical excision of the rudimentary uterine body.     

Microsurgical transposition of the human fallopian tube and ovary with subsequent intrauterine pregnancy

This is the report of a case of a single left unicornuate uterus in a woman whose ipsilateral tube and ovary had been removed subsequent to a left tubal pregnancy. On the right side were present an ovary and a short oviduct (composed of infundibulum and ampulla) immobilized high on the pelvic side wall. Surgical transposition of the right ovary and tube with preservation of their vascular supply permitted anastomosis between the left intramural and the right ampullary tubal segments. The ovary was mobilized to restore a proper spatial relationship with the fimbrial extremity of the tube. In the third postoperative cycle, the patient was successful in achieving an intrauterine pregnancy and has now been delivered of a normal live infant. The potential of microsurgical techniques in restoring fertility in the face of unusual pelvic anatomy is reiterated.     

Bilateral tubal pregnancy after natural conception: a case report

BACKGROUND: Bilateral tubal pregnancy is very rare and usually follows ovulation stimulation. CASE: A 36-year-old woman with acute pelvic pain underwent emergency laparoscopy for suspected left ruptured tubal pregnancy. Bilateral hematosalpinx with a ruptured left tubal pregnancy and active bleeding from the right fallopian tube was noted during surgery, and bilateral salpingectomy was performed by laparoscopy. Pathologic examination of the left tube confirmed the presence of conception products and trophoblastic tissue. The right salpingectomy specimen contained some trophoblastic tissue resembling an earlier tubal pregnancy encased in a cyst. CONCLUSION: This was a rare case of spontaneous bilateral tubal pregnancy after conception at different times. The explanation of the presentation is uncertain. Laparoscopy remains the cornerstone of diagnosis and treatment in the majority of women with a tubal pregnancy; this is especially true in complex cases, such as bilateral tubal pregnancy.     

Unruptured pregnancy in a heterotopic fallopian tube: evidence for transperitoneal sperm migration

A case of an unruptured pregnancy in a heterotopic left fallopian tube isolated from a unicornuate uterus with a normal contralateral tube and ovary is presented. The corpus luteum of pregnancy was in the left ovary. This case provides supportive evidence for transperitoneal sperm migration.     

Term pregnancy after fallopian tube transposition.

A 23-year-old woman suffered from primary sterility because of congenital malformation of the uterus and tubes. There was a left unicornuate uterus. The left ovary and the isthmic and ampullary parts of the right tube were missing. Microsurgical transposition of the left tube was performed successfully. Our technique may encourage microsurgeons to use transposition of fallopian tube in cases in which only one tube and one ovary on contralateral sides are available.     

Investigation of the uterine cavity and fallopian tubes using three-dimensional saline sonohysterosalpingography.

OBJECTIVE: To compare three-dimensional saline sonohysterosalpingography (SHSG) to X-ray hysterosalpingography (HSG) for the evaluation of the uterine cavity and fallopian tubes. PATIENT POPULATION: Fifteen infertile women on whom X-ray HSG had been performed within 1 year prior to this study. METHOD: Fifteen infertile women underwent three-dimensional power Doppler examination of the uterus and fallopian tubes with three-dimensional SHSG during the follicular phase. Distension was achieved using sterile saline injected through a 5 French HSG catheter. Peritoneal accumulation of free fluid surrounding the ovary and tube was required for a diagnosis of a patent tube. Fluid accumulation in the cul-de-sac without visualization of the tubes was considered consistent with at least one tube being patent. RESULTS: three-dimensional saline SHSG was completed in 14 patients. One patient had cervical stenosis and the procedure could not be performed. No significant intrauterine pathology was identified by either X-ray HSG or sonography. Three-dimensional saline SHSG made false positive diagnoses of tubal occlusion in four out of seven fallopian tubes (57%). The sensitivity and specificity for detecting tubal occlusion was 75 and 83%, respectively, with a positive predictive value of 40% and negative predictive value of 95%. Detection of fallopian tube architecture was not possible with three-dimensional saline SHSG in any patient. Simultaneous use of three-dimensional Doppler did not clearly identify the flow of saline through the fallopian tubes. CONCLUSIONS: Transvaginal three-dimensional saline SHSG provides good visualization of the uterine cavity and myometrial walls in three orthogonal planes. However, it does not diagnose tubal occlusion or depict architecture of the fallopian tube as accurately as X-ray HSG. Although we were able to visualize the distal fallopian tube and fimbria with real-time imaging, we were not able to satisfactorily image the proximal tube with three-dimensional power Doppler. This technique may be reserved as an initial screening test to evaluate the uterine cavity and test patency. Patients at high risk for tubal disease by history or with suspected tubal occlusion on three-dimensional saline SHSG should be evaluated by either X-ray HSG or laparoscopy with chromopertubation. Further improvements of three-dimensional technology and contrast materials will, it is hoped, make this method comparable to X-ray HSG.     

Successful pregnancy in a patient with a 46,XY karyotype

OBJECTIVE: To report a case of successful pregnancy in a patient with 46,XY karyotype with primary ovarian failure. DESIGN: Case report. SETTING: Fertility Research Center, G.G. Hospital, Chennai, Tamil Nadu, India. PATIENT(S): A 27-year-old woman with hypoplastic uterus, normal fallopian tubes on both sides, and gonadal dysgenesis. INTERVENTION(S): Chromosomal analysis, diagnostic laparoscopy, donor oocyte program, gamete intrafallopian transfer, and gonadectomy. MAIN OUTCOME MEASURE(S): Response to hormone replacement therapy and the probability of achieving a pregnancy by a tubal procedure. RESULT(S): Treatment was successful, and the patient delivered a live baby. CONCLUSION(S): A hypoplastic uterus of patients with the 46,XY karyotype can be stimulated by the use of cyclical steroid therapy to accommodate pregnancy and facilitate tubal procedures in patients with normal fallopian tubes.     

Bilateral ectopic pregnancy after transfer of two embryos

OBJECTIVE: To report a case of bilateral tubal ectopic pregnancy (EP) after the transfer of two embryos. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 43-year-old multigravida with bilateral tubal pregnancy. INTERVENTION(S): Operative laparoscopy with right linear salpingostomy and left salpingectomy. MAIN OUTCOME MEASURE(S): Laparoscopy revealed an unruptured left isthmic tubal EP and an unruptured right ampullary tubal EP. RESULT(S): Pathology confirmed immature placental villi in the right tube and placental tissue in the left tube. The patient was discharged home without incident on the day after surgery. CONCLUSION(S): This is a rare case of bilateral tubal pregnancy after the transfer of only two embryos. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube after surgery for EP.     

Leiomyoma of the fallopian tube

Leiomyomas of the fallopian tube are rare. They are typically incidental findings seen at autopsy or unrelated surgical procedures. A 32-year-old woman presented with lower abdominal pain and mass. Transvaginal sonogram and magnetic resonance imaging showed the solid mass at the outside of the uterus. At surgery, the left fallopian tube contained a firm mass with torsion in the area of the ampullary-isthmic junction. The left tube and the infundibulopelvic ligament were rolled in torsion and showed edematous change. We report a rare case in whom torsion of a pedunculated tubal leiomyoma caused abdominal pain.