Mwidibo Yusuph, Masunga Daniel S, Rwenyagila Doris, Mlay Joseph, Mremi Alex
Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania; Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Faculty of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of Pathology, Kilimanjaro Christian Medical Center, Moshi, Tanzania; Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
Int J Surg Case Rep. 2024 Oct;123:110248. doi: 10.1016/j.ijscr.2024.110248. Epub 2024 Sep 6.
Uterine anomalies are congenital malformations caused by fusion or resorption defects during embryogenesis. A bicornuate uterus is a rare condition that results from abnormal development of the paramesonephric ducts. It results from an incomplete fundus-level fusion of uterovaginal horns.
A 30-year-old female presented with a longstanding abdominal distension. An abdomino-pelvis CT scan result was suggestive of a huge right ovarian mass (25.8 × 25.9 × 14.3 cm). Intraoperatively, a bicornuate uterus with normal left cornua was encountered. The right cornua was not extending to the vagina vault and had a huge cystic mass arising from the fundus. The right cornua excision along with the mass was performed, preserving the left normal cornua and its adnexa. Histopathology confirmed the diagnosis of leiomyoma. The patient was kept in follow-up. To date, six months have passed; she has resumed her menstrual cycles and is free from symptoms.
Symptomatic fibroids in patients with a birconuate uterus are rare. Thus, diagnostic challenges can be encountered, as was seen in this case. A huge size of the fibroid in one horn of the bicornuate uterus projecting into the pelvic cavity can contribute to recurrent pregnancy loss. An MRI of the pelvis is recommended for assessment of the internal and external contours of the uterus.
A bicornuate uterus with lieomyomas is an uncommon but difficult condition. An appropriate pre-operative assessment of the mullerian anomaly type, quantity, location, and size of lieomyomas, as well as urinary tract mapping, are essential for effective management.
子宫畸形是胚胎发育过程中由融合或吸收缺陷引起的先天性畸形。双角子宫是一种罕见的情况，由副中肾管发育异常导致。它是由于子宫阴道角在宫底水平融合不完全所致。
一名30岁女性因长期腹胀就诊。腹部盆腔CT扫描结果提示右侧卵巢有巨大肿块（25.8×25.9×14.3厘米）。术中发现为双角子宫，左侧宫角正常。右侧宫角未延伸至阴道穹窿，宫底有一个巨大的囊性肿块。切除右侧宫角及其肿块，保留左侧正常宫角及其附件。组织病理学确诊为平滑肌瘤。患者进行随访。迄今为止，已过去六个月；她已恢复月经周期且无症状。
双角子宫患者出现症状性肌瘤较为罕见。因此，如本病例所见，可能会遇到诊断挑战。双角子宫一侧宫角内巨大的肌瘤突入盆腔可导致复发性流产。建议进行盆腔MRI检查以评估子宫的内部和外部轮廓。
合并平滑肌瘤的双角子宫是一种罕见但棘手的情况。对苗勒管畸形类型、平滑肌瘤的数量、位置和大小进行适当的术前评估，以及尿路造影，对于有效治疗至关重要。
