SUCCESSFUL LAPAROSCOPIC MANAGEMENT IN A CASE OF RUPTURED SECOND TRIMESTER RUDIMENTARY HORN PREGNANCY

Dr. Namdev Bhure, *Dr. Snehal Shinde, Dr. Shankar Chavan, Dr. Pramod Junjare, Dr. Shrihari Gutte

ABSTRACT

Background: Pregnancy in rudimentary horn of unicornuate uterus is rare however if not diagnosed timely it can lead to devastating outcome. This case report shows how one such case of ruptured rudimentary horn pregnancy at 18 weeks gestation was managed successfully with laparoscopic approach. Case Description: We report a case of 20years, primigravida with 18 weeks gestation presenting with complaints of severe abdominal pain, giddiness with cold clammy extremities. On clinical examination patient was in a state of shock with severe pallor. Per abdominal examination revealed abdominal distension with tenderness in hypogastrium. With ongoing aggressive resuscitative measures bedside ultrasound was done which revealed gross fluid in abdomen with internal echoes, empty uterine cavity with intraabdominal ensac fetus with absent cardiac activity. Differential diagnosis made upon this were of rupture uterus or abdominal pregnancy with hemoperitoneum in shock. Patient was immediately taken for laparoscopic management. Intraoperative findings noted were gross hemoperitoneum with ensac expulsion of fetus with placenta from ruptured rudimentary horn on right side. Excision of ruptured rudimentary horn with right salpingectomy was then performed with bipolar shearer. Posterior colpotomy was done with bipolar shearer. Specimen retrieval was completed vaginally through colpotomy incision. Her postoperative span was uneventful and she was discharged on post operative day 5. Patient was thus successfully managed with minimal access surgical approach aided by vaginal retrieval of specimen. Conclusion: Pregnancy in rudimentary horn poses a diagnostic challenge. Laparoscopic management seems safe and feasible even in cases of ruptured rudimentary horn pregnancies provided the prerequisites of surgical expertise in advanced laparoscopy aided with multidisciplinary team approach are met.

Keywords: Rudimentary Horn Pregnancy (RHP), Unicornuate uterus, Laparoscopic management, Ruptured rudimentary horn pregnancy.