جستجوی مقالات مرتبط با کلیدواژه "unicornuate uterus" در نشریات گروه "پزشکی"

Uterine anomalies have been caused by impairment in the formation, evolution, or defect in the connection of Mullerian bud during the embryonic period. In this study, a case of unicornuate uterus with cervical agenesis is presented.

The patient was a 14-year female with symptoms of backache, pain in the left thigh, nausea, vomiting, and chill, which were started six months ago (no complain of abdominal pain). Sonography was performed and a cystic appendage with a thick wall containing internal eco and somewhat septa solid components appeared in the sinistral pelvis, indicating the sinistral rudimentary horn of the uterus with hematometra (secondary to cervical agenesis). Sonography showed a 32×92 mm twist tubular cystic appendage having an internal eco in left lower quadrant, indicating hydrosalpinx. No left ovary tissue was observed. Hymen was checked and it was imperforate. Due to cervical agenesis, blind vagina and hydrosalpanx, hysterectomy and left salpingectomy surgeries were performed. The pathological answer showed cervical  agenesis and  a unicornuate uterus containing hematometra and hematosalpinx in the left fallopian tube and endometrioma cyst.

Gynecologic problems should be considered in adolescents with initial amenorrhea and abdominal pain.

Uterine anomalies are caused by impairment in the formation, evolution, or defect in the connection of Mullerian bud in the embryonic period, and the prevalence of these disorders is 2% to 4% in the population of women of reproductive age. Unicornuate uterus is one of the types of uterine anomalies in which one of the Mullerian ducts has normal growth, and therefore a normal cavity is formed along with the uterine and vascular tract, but different degrees of growth disturbance is seen in the other Mullerian duct (from no growth to existence of rudimentary horn with or without cavity and so on). One of the complications of uterine development disorders is pregnancy in rudimentary horn.

The patient was a 17-year-old woman with ectopic pregnancy in non-communicating rudimentary horn of unicornuate uterus that was mistakenly diagnosed as an ectopic pregnancy in a normal fallopian tube and treated with methotrexate and was referred as a persistent ectopic pregnancy and no response to methotrexate for surgical treatment. The patient underwent laparoscopy and then with diagnosis of pregnancy in the unrelated anterior horn, the pregnancy products and the left tube were removed and the left ovary was preserved. The patient was discharged after 2 days with good general condition.

In the case of initial diagnosis of ectopic pregnancy, precise follow-up should be performed in terms of decrease in beta-HCG circulation; in the case of no increase in beta-HCG or if beta-HCG was stable despite methotrexate treatment, further investigations through Ultrasound, MRI, laparoscopy, and hysteroscopy be performed to diagnose uterine anomalies. The presence of uterine rudimentary horn in cases of stable ectopic pregnancy, despite being rare should be considered as one of the possible cases and the patient is transferred to operation room with previous preparation.