Department of Obstetrics and Gynecology, Well Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
J Med Case Rep. 2023 May 12;17(1):210. doi: 10.1186/s13256-023-03882-5.
Rudimentary horn pregnancy is a rare life-threatening obstetric condition with clinical and sonographic presentation resembling that of an abdominal pregnancy. Preoperative diagnosis of advanced rudimentary horn pregnancy is difficult and cases are often identified incidentally during laparotomy for a presumed abdominal pregnancy.
We report a case of a 29-year-old African woman, gravida 2 para 1 at 28 weeks of gestation complaining of epigastric pain for 7 days with no other associated gastrointestinal or genitourinary symptoms. On examination, she had normal vital signs and an enlarged abdomen sized at 33 cm with unremarkable fetal lie and presentation. She had normal laboratory blood results with an ultrasound revealing an abdominal pregnancy of 28 weeks. The informed decision for conservative management was planned after informing of the benefit and risks of early termination versus conservative management, however, with worsening symptoms an emergency laparotomy had to be performed in which a left unruptured rudimentary horn pregnancy with a viable fetus was identified incidentally and delivery of the fetus followed by surgical excision of the horn was done. The postoperative period was uneventful, and the patient was discharged home with her newborn.
Rudimentary horn pregnancy is very rare and often indistinguishable from an abdominal pregnancy in advanced gestation age. First trimester ultrasound is by far the only noninvasive sensitive diagnostic modality for rudimentary horn pregnancy. Laparotomy with horn excision remains the standard of care for advanced rudimentary horn pregnancy.
残角子宫妊娠是一种罕见的危及生命的产科疾病，其临床表现和超声表现类似于腹腔妊娠。高级残角妊娠的术前诊断较为困难，且常于剖腹探查诊断为疑似腹腔妊娠时偶然发现。
我们报告了一例 29 岁非洲妇女，妊娠 2 次，产 1 次，妊娠 28 周，诉上腹疼痛 7 天，无其他胃肠道或泌尿生殖系统相关症状。体格检查生命体征正常，腹部增大，大小为 33cm，胎先露和胎位正常。实验室血液检查结果正常，超声显示 28 周的腹腔妊娠。在告知早期终止妊娠与保守治疗的利弊后，计划进行保守治疗，但由于症状恶化，不得不进行紧急剖腹手术，偶然发现左侧未破裂的残角妊娠，有存活胎儿，随后进行胎儿分娩和残角切除手术。术后恢复顺利，患者带着新生儿出院回家。
残角子宫妊娠非常罕见，且在妊娠晚期常与腹腔妊娠难以区分。早孕超声检查是目前唯一一种非侵入性、敏感的残角妊娠诊断方法。对于晚期残角妊娠，剖腹手术切除残角仍然是标准的治疗方法。
