Laparoscopic Management of a Rudimentary Horn Ectopic Pregnancy

Abstract

Study Objective

To showcase and report on the successful laparoscopic treatment of a rare diagnosis of an ectopic pregnancy in a noncommunicating rudimentary horn in a patient with prior successful, spontaneous, and uncomplicated pregnancy in her known unicornuate uterus.

Design

Retrospective Case Study

Setting

An urban academic teaching hospital.

Patients or Participants

Representative single case study of a patient of an OBGYN, MFM, and MIGS practice who underwent laparoscopic surgical treatment of a rudimentary horn ectopic pregnancy.

Interventions

Diagnostic laparoscopy, excision of noncommunicating rudimentary horn and ectopic pregnancy within, right salpingectomy.

Measurements and Primary Results

We present a 34 year old G2P1001 with a known unicornuate uterus and non-communicating rudimentary horn who was diagnosed with a rudimentary horn pregnancy at 6 weeks gestational age. MRI imaging revealed no communication between the uterus and horn, leading to hypothesis of peritoneal migration of sperm. After thorough MFM and MIGS subspecialty counseling, the patient underwent laparoscopic resection of the rudimentary horn ectopic pregnancy. Our case highlights the vital role of pre-operative planning with appropriate imaging techniques, preoperative planning to ensure hemostasis, and tenets of appropriate surgical technique to use for safe excision of a rudimentary horn.

Conclusion

Rudimentary horn ectopic pregnancies are rare, and risk of uterine rupture is estimated to be as high as 80% for a gravid rudimentary uterine horn, typically occurring before the third trimester, and can result in hemorrhage requiring emergency surgery. We conclude that appropriate preoperative planning and surgical technique are vital in safe treatment of these pregnancies. We highlight the importance of pre-pregnancy counseling in women with uterine anomalies and reinforces the role of minimally invasive surgery in safely managing complex ectopic gestations.