Mohd Sakri, Noor Asikin and Abu Ishak, Nurkhairulnisa and Zakirai@Zakaria, Norlisa and Ali, Atiqah
(2025)
Hemi-hysterectomy for non-communicating functional
rudimentary horn in patients with unicornuate uterus: a
case series.
In: 2nd Asia Oceanic Society of Paediatric & Adolescent Gynaecology (AOSPAG) Congress, 11/09/2025 - 13/09/2025, Holiday Inn, Bangsar, Kuala Lumpur.
Abstract
Introduction: Congenital uterine anomalies, particularly unicornuate uterus with a noncommunicating functional rudimentary horn, are rare malformations arising from incomplete Müllerian duct development. These anomalies can present in adolescence with severe dysmenorrhea, hematometra, and endometriosis. Surgical excision of the obstructed horn is essential to relieve symptoms and prevent future complications. We present two cases of patient managed with left hemi-hysterectomy for symptomatic non-communicating functional rudimentary horn.
Case presentation: Case 1: This case involves a 23-year-old with Kartagener syndrome and a longstanding history of dysmenorrhea and pelvic pain since adolescence. Imaging confirmed a right unicornuate uterus with a non-communicating functional left rudimentary horn, complicated by left hematometra, endometrioma, and hydrosalpinx. Following failed medical therapy, she underwent a laparotomy with left hemi-hysterectomy and left salpingooophorectomy. Postoperatively, she achieved regular,
pain-free menses and resolution of symptoms.
Case 2: This case describes a 14-year-old girl who presented with progressively worsening dysmenorrhea and was diagnosed with OHVIRA-like anatomy. MRI confirmed a right unicornuate uterus with a non-communicating functional left horn, left hematosalpinx, endometrioma and ipsilateral renal agenesis. She underwent elective laparotomy with excision of the left rudimentary horn, salpingectomy and drainage of the endometrioma. Recovery was uneventful, with complete symptom resolution and regular menstruation maintained over two-year follow-up period.
Discussion: Both cases exemplify the classical presentation of obstructive Müllerian anomalies in adolescents, often associated with renal anomalies. Despite different ages and comorbidities, both
patients shared the same pathophysiological mechanism leading to cyclical pain and hematometra. MRI proved crucial in preoperative planning, and definitive surgical excision of the rudimentary horn resulted in significant clinical improvement.
Conclusion: A non-communicating functional rudimentary horn should be considered in adolescents with severe dysmenorrhea and suspected uterine anomalies. Early diagnosis and surgical excision are key to symptom relief, prevention of endometriosis, and preservation of future fertility. A multidisciplinary approach enhances outcomes, especially in patients with comorbidities such as Kartagener syndrome or renal agenesis.
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