Adenomyosis and Hematometra in a Non-communicating Rudimentary Horn of a Unicornuate Uterus: A Case Report

Abstract

Congenital uterine anomalies with outflow tract obstruction caused by abnormal Mullerian duct system development are rare conditions that can lead to painful pelvic emergencies such as hematometra. A unicornuate uterus with a rudimentary horn occurs in about 2.4–13% of all Müllerian duct anomalies with a prevalence of 1 in 100000 fertile women. Clinical symptoms such as dysmenorrhea, dyspareunia, and acute and chronic pelvic pain usually develop at and after menarche. Accurate diagnosis and timely surgical intervention are crucial to prevent complications such as adenomyosis, endometriosis, and infertility. A 21-year-old nulligravida Afghan female presented with severe chronic pelvic pain that worsened during menstruation and coitus. Ultrasonography and magnetic resonance imaging (MRI) revealed two separate uterine bodies. The left body was a unicornuate uterus with an endometrial lining connected to the cervix and the vaginal canal. The right body showed a functioning non-communicating rudimentary horn containing hematometra without a cervical opening. The patient underwent a hemi-hysterectomy and the rudimentary horn was removed. The histopathological findings revealed adenomyosis with cystic changes. The patient recovered after the operation and her severe pain subsided. This case underscores the importance of timely diagnosis and management of rare non-communicating functioning rudimentary horn anomalies that occur in less than 0.06% of reproductive-age women. Notably, this report adds to the limited literature on this anomaly where the rudimentary horn contained extensive adenomyosis, highlighting the potential for significant histopathological changes in such anomalies. Precise diagnosis and surgical excision are critical to prevent complications.