Treatment of patients with non-communicating horns with cavity

Abstract

Aim: The aim of this chapter is to present the clinical manifestations and the various alternatives for the treatment of rudimentary horns with cavity in cases of vaginal aplasia and hemi-uterus, by reviewing all the available data from case series and case reports. Complications and questions raised for the proper management are also addressed. Brief description of the reviewed data: Rudimentary horns with cavity could be found in patients with hemi-uterus and in patients with uterine aplasia. Their presence is clinically significant since it is usually associated with pelvic pain. Pregnancy in the rudimentary horn of patients with hemi-uterus is a rare life-threatening complication due to horn rupture usually during the mid-second trimester. Three dimensional ultrasound and magnetic resonance imaging is the recommended diagnostic tools with high accuracy. Laparoscopic removal of symptomatic functional rudimentary horns is the established surgical treatment for those patients. Restoration of continuity is another feasible surgical treatment alternative but only in highly selected cases after thorough consultation. Clinical implications: In view of this evidence, patients with hemi-uterus or uterine aplasia should be carefully investigated for the presence of a rudimentary functional horn. Any pregnancy in a rudimentary horn of a hemi-uterus should be considered and treated as “topic” due to the high risk for late rupture and the resulted intra-peritoneal bleeding. Open issues for further research: Although excision of functional rudimentary horns is recommended in symptomatic patients, it is not yet clear which asymptomatic patients should be also treated. The safety, the benefits and the selection criteria for the alternative surgical option of continuity restoration need also further investigation. Another open issue is the age at what surgical approach is most convenient. Due to low prevalence of women with rudimentary functional horns, larger number of patients and a systematic review of them are essential to withdraw valuable conclusions.