A Rare Case of Ruptured Rudimentary Horn Pregnancy

Abstract

Unicornuate uterus with non communicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultra sonography is technically difficult, with sensitivity of 30%. We report a case of ruptured                     non-communicating rudimentary horn at 20 weeks in a woman with previous Caesarean delivery. She presented to emergency in shock, with massive hemoperitoneum and ruptured horn. Intraoperatively a unicornuate uterus with rupture of non communicating rudimentary horn was confirmed and a dead fetus was found in peritoneal cavity with 2.5 liters of hemoperitoneum. Timely laparotomy, excision of the horn, and blood transfusion saved the patient. A high index of suspicion is warranted in cases of advanced gestation presenting with acute abdomen, especially in developing countries like India, where the possibility of early detection before rupture is unlikely, culminating in maternal demise.