An unusual case of rudimentary uterine horn ectopic pregnancy.

Case Report A 23-year-old single lady was referred to our institution’s Emergency Department for the suspicion of ectopic pregnancy after an ultrasound scan performed by a private practitioner. She had initially requested for a termination of pregnancy. At 10 weeks amenorrhoea, she did not have any abnormal symptoms such as abdominal pain or vaginal bleeding. A transvaginal pelvic ultrasound was performed which demonstrated the presence of a gestational sac containing a fetus measuring 33 mm via crown-rump length located superior to the uterine fundus next to the right adnexal region. No intrauterine pregnancy was seen. This “extra-gestational fetus” corresponded to 10 weeksize with a fetal heart rate of 175 beats per minute (Fig. 1). There were no other pelvic masses nor fluid within the Pouch of Douglas. Differential diagnoses included tubal ectopic pregnancy and uterine cornual interstitial pregnancy. In view of the substantial size of the ectopic pregnancy, decision was made to remove it surgically via laparoscopic excision or salpingectomy. Intra-operatively, there was the presence of a unicornuate uterus which was deviated to the right by a large 10 week-size left adnexal mass (Fig. 2). This left adnexal mass appeared to be connected to the unicornuate uterus by a thin fibrous strand, and the left fallopian tube was traced to be seen arising from this adnexal mass (Figs. 3 and 4). On the other side, the unicornuate uterus gave rise to the right fallopian tube but was not linked to the left fallopian tube. Both the ovaries and fallopian tubes appeared normal otherwise. The left adnexal mass was diagnosed a rudimentary horn ectopic pregnancy upon laparoscopic excision and retrieval, when the fetus was found within. The ectopic specimen was retrieved using an Endo CatchTM bag. Meanwhile, both the ureters were traced which were normal in anatomy. Moreover, vaginal examination of the cervix and vagina established the presence of only one vagina and one cervix with the endocervical canal leading into the unicornuate uterine cavity. The post-operative recovery was uneventful. An Unusual Case of Rudimentary Uterine Horn Ectopic Pregnancy