Preoperative value of CT angiography in the laparoscopic removal of rudimentary uterine horn
© Springer-Verlag 2006
Received: 21 June 2006
Accepted: 21 October 2006
Published: 22 November 2006
Computed tomography (CT) angiography, a minimally invasive technique for vascular imaging, has been shown to be an excellent tool for imaging the pelvic arteries and their branches. This report describes the accuracy of CT angiography in the preoperative evaluation of the blood supply for laparoscopic dissection of rudimentary horn. The rudimentary horn was successfully removed laparoscopically with minimal blood loss.
Women who have a non-communicating uterine horn may present after menarche with progressive abdominal pain caused by hematometra, hematosalpinx, and endometriosis. However, many women remain asymptomatic. Pregnancy in a rudimentary uterine horn is associated with acute uterine rupture. The key to successful management is early detection and surgical removal before pregnancy . Computed tomography (CT) angiography, a minimally invasive technique for vascular imaging, has been shown to be an excellent tool for imaging the pelvic arteries and their branches [2, 3]. This report describes the accuracy of CT angiography in the preoperative evaluation of the blood supply for laparoscopic dissection of rudimentary horn.
Initial inspection revealed normal tubes and ovaries bilaterally and a uterus with two completely separate uterine horns. The left rudimentary horn was attached to the right horn by a band of tissue. This band of tissue was coagulated by means of bipolar cautery and transsected, thereby facilitating the separation of the rudimentary horn and confirming the absence of the uterine artery after dissection of a bladder flaps. The round ligament, utero-ovarian ligament and mesosalpinx were then cauterized and cut with minimal blood loss. The endometrium was excised from the remaining myometrial flaps of the right horn. These flaps were closed over the intact midline septum, which was fibrous in appearance. Histology was consistent with a non-communicating rudimentary horn.
Approximately 90% of these unicornuate uteri with a rudimentary horn are non-communicating, but fine anatomical variations may be encountered, particularly in the attachment of the rudimentary horn to the unicornuate uterus [1, 4]. The unicornuate uterus with a rudimentary horn can be either fixed or separated. Assessment of whether the horn is separated or non-separated can provide important clues as to the likely site of the uterine artery. Rudimentary horns of the separate type, in particular without a blood supply through the uterine artery, as experienced in our case, have been successfully removed laparoscopically . For non-separated horns, bleeding and compromise of the wall thickness of unicornuate uterus can occur, and extirpation may best be done by laparotomy. The CT angiographic technique should be brought to the attention of laparoscopic surgeons and may be used in some cases to improve laparoscopic management of Mullerian anomalies.
- Jayasinghe Y, Rane A, Stalewski H, Grover S (2005) The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol 105:1456–1467PubMedGoogle Scholar
- Brink J (1997) Spiral CT angiography of the abdomen and pelvis: interventional applications. Abdom Imaging 22:365–372PubMedView ArticleGoogle Scholar
- Prokop M, Schaefer-Prokop C, Galanski M (1997) Spiral CT angiography of the abdomen. Abdom Imaging 22:143–153PubMedView ArticleGoogle Scholar
- Pinsonneau O, Goldstein D (1985) Obstructing malformations of the uterus and vagina. Fertil Steril 44:241–270Google Scholar
- Perrotin F, Bertrand J, Body G (1999) Laparoscopic surgery of unicornuate uterus with rudimentary uterine horn. Hum Reprod 14:931–933PubMedView ArticleGoogle Scholar