Non-communicating Rudimentary Horn with Haematometra Manifesting as Adnexal Mass: A Case Report

1. Junior Resident, Department of Radiodiagnosis, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpet, Tamil Nadu, India. 2. Professor, Department of Radiodiagnosis, SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpet, Tamil Nadu, India.

Abstract

Female reproductive organs other than ovaries are formed from the mullerian ducts which develop into fallopian ducts, uterus, and the upper two third of vagina. Any defective formation and non-fusion of Müllerian ducts leads to multiple anomalies with varying combinations with variable presentations in these affected women. Anomalies like rudimentary horn without non-functional endometrium are asymptomatic and incidentally diagnosed while undergoing imaging studies like ultrasound and magnetic resonance imaging of pelvis. Anomalies of rudimentary horn with functional endometrium, patients may have dysmenorrhoea, abnormal bleeding at the time of menarche, ectopic pregnancy in the rudimentary horn, and endometriosis. The patient might experience a delayed onset of presentation, and some women may end up with life-threatening conditions such as ruptured ectopic pregnancy in the rudimentary horn. A 35-year-old female with a history of dysmenorrhoea for 15 years and recent aggravated pain, presented for imaging of the pelvis. Right adnexal lesion was suggested during the ultrasound imaging, and the Magnetic Resonance Imaging (MRI) pelvis suggested a rudimentary horn on the right-side with blood collection within the horn, causing haematometra. Laparoscopic removal of the rudimentary horn was done, and the presence of functional endometrium and myometrial tissue was confirmed in the histopathological examination. Early detection of these mullerian anomalies will help us prevent the morbidity and mortality associated with them.

Congenital uterine malformation, Dysmenorrhoea, Müllerian anomalies, Pelvic pain, Unicornuate uterus