Laparoscopic conservative approach to noncommunating rudimentary uıterin horn pregnancy

20 yaşında kadın hasta sekonder amenore ve sağ alt kadran ağrısı şikayetleri ile kliniğimize başvurdu. Transvajinal ultrasonografide, kalp atımı olmayan embriyo sağ adneksiyal bölgede gözlendi. Laparoskopide bikornu uterus görünümü mevcuttu. Histereskopide sol kornuya girildi, burada gestasyonel kesenin olmadığı görüldü ve unikornu görünüm izlendi. Ektopik gebeliğin non-komünike sağ hornda olduğuna karar verildi. Laparos kopi ile lineer insizyon uygulandı ve gebelik materyali boşaltılıp insizyon primer tamir edildi. Operasyondan iki ay sonra çekilen histerosalpingografide rudimenter hornun kaviteyle bağlantısı olmadığı görüldü ve hastaya laparatomi ile metroplasti yapıldı. Cerrahiden 2 ay sonra ofis histereskopi ile kavitenin yeterli olduğu görüldü. 6 ay sonra hasta gebe kaldı ve 37. haftada sezeryan ile doğurtuldu. Yeterli büyüklükte olan ve içinde aktif endometriyum dokusu bulunan rudimenter hornlarda eksizyon yerine metroplasti operasyonu uygulanabilir.

Nonkomünikan rudimenter horn gebeliğine laparoskopik konservatif yaklaşım

A 20 year old patient referred to our clinic with complaints of secondary amenorrhea and pain. In transvaginal ultrasonography, an embryo was observed with no cardiac activity at right adnexial area. In the laparoscopy, it was seemed like bicornuate uterus.In hysteroscopy, normal left cornu, where gestational sac was not present,was entered. For this reason, unruptured ectopic pregnancy was considered in right rudimentary horn. By laparoscopy, linear incision was carried out, pregnancy material was evacuated and incision repaired primarily. Two months later, it was observed that rudimentery horn was not communicated with uterine cavity by histerosalpingography. Then, metroplasty with laparatomy was carried out. Six months later patient had had a pregnancy and delivered by cesarean section while the fetus was at the 37th gestational week. If rudimentary horn has adequate size and active endometrial tissue, metroplasty operation could be performed instead of horn excision in selected patients.

Kaynakça

1. Cash R.L, Rahmani R,Herer E.R. First Trimester Screening Aids in the Diagnosis and Management of an Ectopic Pregnancy in a Noncommunicating Uterine Horn. J Clin Ultrasound 2006;34: 446-9.

2. Samuels T.A, Awonuga A.Second -Trimester Rudimentary Uterine Horn Pregnancy. Obstet Gynecol 2005;106:1160-2.

3. AydemirV, BozkayaH, Ulusoy M, Pregnancy in a noncommunating rudimentary uterine horn.Isr J Med Sci 1993;29:314-5.

4. Chang J.C, Lin Y.C.Rupture of rudimentary horn pregnancy. Acta Obstet Gynecol Scand 1992;71:235-8.

5. Nishi H, FunayamaH, FukumineN, et.al. Rupture of pregnant noncommunicating rudimentary uterine horn with fetal salvage:a case report.Arch Gynecol Obstet 2003; 268:224-6.

6. Heinonen PK. Unicornuate uterus and rudimentary horn Fertil Steril 1997;68:224-30.

7. Okonta PI, Abedi H, Ajuyah C, Omo-Aghoja L. Preg nancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report. Cases J. 2009;2:6624.

8. Gerard G.Nahum.Rudimentary Uterine Horn Pregnancy: The 20th-Century Worldwide Experience of 588 Cases.J Reprod Med 2002;47:151-63.

Kaynak Göster

  • ISSN: 1300-4751
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1995

4.3b 2.4b

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