A case study summary of Surgical Management of Rudimentary Uterine Horns

Uterine malformations involving a rudimentary horn are uncommon, affecting 2% to 4% of women. These malformations arise from the incomplete fusion of the Müllerian ducts around seven weeks of pregnancy, leading to conditions such as unicornuate uterus or rudimentary horns, which may or may not possess a cavity and can be either connected or disconnected from the main uterine cavity. According to the American Fertility Society, these are categorized as class II Müllerian anomalies. In 20-30% of cases, they are linked to renal issues, particularly unilateral renal agenesis. Diagnosing a rudimentary uterine horn can be challenging, as many women remain asymptomatic, with diagnoses often made incidentally during infertility assessments or unrelated surgeries. Symptoms can manifest at menarche or later, including chronic pelvic pain, dysmenorrhea, and complications related to ectopic pregnancies or recurrent miscarriages.

This article aims to detail a straightforward 10-step surgical procedure for removing a rudimentary horn, which has been validated for efficacy and safety in prior studies. The surgery offers potential benefits, including reduced dysmenorrhea, prevention of endometriosis, and decreased risk of ectopic pregnancy.

The patient with primary infertility had the malformation identified during pre-assisted reproductive technology evaluations. The surgical approach included steps such as abdominal exploration, tests for communication between the horn and main cavity, and excision of the horn itself, performed under general anesthesia with antibiotic prophylaxis. Postoperative care was uncomplicated, with patients discharged on the first day following surgery, and anatomical analysis confirming the presence of a rudimentary horn.

She was advised to wait 3 to 6 months before attempting pregnancy, while no specific recommendations were given for the others due to the absence of cavity invasion. The authors emphasized the need for thorough preoperative imaging to locate the rudimentary horn and check for associated renal anomalies.

In conclusion, while rudimentary uterine horns are rare, their removal is recommended due to their potential impact on fertility and associated symptoms. The surgical procedure is straightforward, with no formal contraindications, providing multiple benefits for patients. There is a lack of literature on follow-up care for subsequent pregnancies, underscoring the need for individualized decisions regarding delivery routes based on the patient's specific circumstances.

Source: Lesur P, et al. 10-steps laparoscopic excision for a rudimentary uterine horn. Journal of Gynecology Obstetrics and Human Reproduction. 2025,54(5):102930, ISSN 2468-7847. https://doi.org/10.1016/j.jogoh.2025.102930.