Limits...
Spontaneous second-trimester ruptured pregnancy of rudimentary horn: a case report in Yaounde, Cameroon.

Fouelifack FY, Fouogue JT, Messi JO, Kamga DT, Fouedjio JH, Sando Z - Pan Afr Med J (2014)

Bottom Line: We performed an excision of the rudimentary horn with ipsilateral salpingectomy.Post-operative course was uneventful and the woman was discharged seven days later.This case emphasizes the importance of good antenatal care to avoid complications.

View Article: PubMed Central - PubMed

Affiliation: Obstetrics and Gynecology Unit of the Yaounde Central Hospital, Yaounde, Cameroon.

ABSTRACT
Rudimentary uterine horn pregnancy is rare and, to our knowledge, has not been previously reported in Cameroon. We herein report the case of a 22 year old second gravida referred for acute abdominal pain at 17 weeks of gestation. Physical examination revealed hemoperitoneum with hypovolemic shock. After resuscitation, an emergency exploratory laparotomy was done and we found hemoperitoneum of 3,500 milliliters, a bicornuate uterus with a ruptured right rudimentary communicating horn containing a non viable foetus. There were no other abnormalities. We performed an excision of the rudimentary horn with ipsilateral salpingectomy. Post-operative course was uneventful and the woman was discharged seven days later. This case emphasizes the importance of good antenatal care to avoid complications.

Show MeSH

Related in: MedlinePlus

View of the operative field showing the non viable foetus and the ruptured rudimentary uterine horn
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4231311&req=5

Figure 0001: View of the operative field showing the non viable foetus and the ruptured rudimentary uterine horn

Mentions: Miss EL is a 22 year old, G2P1001 student, referred to our emergency setting for an abdominal pain evolving since 12 hours, in a pregnancy of 17 weeks. That abdominal pain started abruptly 12 hours prior to consultation. It was diffuse, of moderate intensity and without irradiation. This motivated an unfruitful automedication with mebeverine. A sudden and sharp raise of intensity motivated a consultation in a health center from where she was immediately referred to out setting. The patient had her first menses at 14 years. She bleeds for 5 days every 30 days. She has never had neither dysmenorrhoea nor dyspareunia. She had no method of contraception. Her first pregnancy resulted in a normal delivery of a live baby boy weighing 3,450 grammes two years earlier. The current pregnancy was 17 weeks and was poorly followed up in a health center. Her medico - surgical and social past history was unremarkable. Clinical assessment on admission revealed a hemorrhagic shock characterized by: asthenia, vomiting, vertigo, restlessness, anxiety, a blood pressure of 80/55 millimeters of mercury, a pulse rate of 123 pulsations /minute, a respiratory rate of 28 cycles/minutes. The temperature was 37.3 degree Celsius. Conjunctivae were pale. Chest examination revealed tachycardia and polypnea. The abdomen was distended, symmetrical, tender and dull at the percussion. Bowel sounds were absent. Vaginal speculum revealed no abnormality. On digital vaginal exploration, the cervix was posterior, long and closed. Posterior cervical fornix was full and painful. Cervical motion tenderness was noted but bimanual exam was limited by pain. A paracentesis brought back 8 millimeters of non clotting blood. The working diagnosis was a ruptured ectopic pregnancy and the differential diagnosis was ruptured ovarian cyst in pregnancy. An emergency laparotomy was indicated and a preoperative workup done, showing a hemoglobin level of 6.4 grammes per deciliter. Resuscitation and monitoring were immediately started with mask oxygen, intravenous fluids, blood transfusion, in-dwelling Foley's catheter and painkillers. After informed consent, surgery was started three hours after admission. This delay was due technical (availability of blood and emergency medicines), financial (lack of money to buy emergency drugs) and human resource (small number of anesthetists on call duty at night) constraints. Operative findings were: a hemoperitoneum of 3,500 milliliters, a bicornuate uterus with a ruptured right rudimentary non-communicating horn containing a non viable foetus weighing 280 grammes and macroscopically normal fallopian tubes and ovaries (Figure 1). Excision of the rudimentary horn and ipsilateral salpingectomy were done and the patient received four pints of packed red blood cells. Uneventful post-operative course followed and the woman was discharged seven days later.


Spontaneous second-trimester ruptured pregnancy of rudimentary horn: a case report in Yaounde, Cameroon.

Fouelifack FY, Fouogue JT, Messi JO, Kamga DT, Fouedjio JH, Sando Z - Pan Afr Med J (2014)

View of the operative field showing the non viable foetus and the ruptured rudimentary uterine horn
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231311&req=5

Figure 0001: View of the operative field showing the non viable foetus and the ruptured rudimentary uterine horn
Mentions: Miss EL is a 22 year old, G2P1001 student, referred to our emergency setting for an abdominal pain evolving since 12 hours, in a pregnancy of 17 weeks. That abdominal pain started abruptly 12 hours prior to consultation. It was diffuse, of moderate intensity and without irradiation. This motivated an unfruitful automedication with mebeverine. A sudden and sharp raise of intensity motivated a consultation in a health center from where she was immediately referred to out setting. The patient had her first menses at 14 years. She bleeds for 5 days every 30 days. She has never had neither dysmenorrhoea nor dyspareunia. She had no method of contraception. Her first pregnancy resulted in a normal delivery of a live baby boy weighing 3,450 grammes two years earlier. The current pregnancy was 17 weeks and was poorly followed up in a health center. Her medico - surgical and social past history was unremarkable. Clinical assessment on admission revealed a hemorrhagic shock characterized by: asthenia, vomiting, vertigo, restlessness, anxiety, a blood pressure of 80/55 millimeters of mercury, a pulse rate of 123 pulsations /minute, a respiratory rate of 28 cycles/minutes. The temperature was 37.3 degree Celsius. Conjunctivae were pale. Chest examination revealed tachycardia and polypnea. The abdomen was distended, symmetrical, tender and dull at the percussion. Bowel sounds were absent. Vaginal speculum revealed no abnormality. On digital vaginal exploration, the cervix was posterior, long and closed. Posterior cervical fornix was full and painful. Cervical motion tenderness was noted but bimanual exam was limited by pain. A paracentesis brought back 8 millimeters of non clotting blood. The working diagnosis was a ruptured ectopic pregnancy and the differential diagnosis was ruptured ovarian cyst in pregnancy. An emergency laparotomy was indicated and a preoperative workup done, showing a hemoglobin level of 6.4 grammes per deciliter. Resuscitation and monitoring were immediately started with mask oxygen, intravenous fluids, blood transfusion, in-dwelling Foley's catheter and painkillers. After informed consent, surgery was started three hours after admission. This delay was due technical (availability of blood and emergency medicines), financial (lack of money to buy emergency drugs) and human resource (small number of anesthetists on call duty at night) constraints. Operative findings were: a hemoperitoneum of 3,500 milliliters, a bicornuate uterus with a ruptured right rudimentary non-communicating horn containing a non viable foetus weighing 280 grammes and macroscopically normal fallopian tubes and ovaries (Figure 1). Excision of the rudimentary horn and ipsilateral salpingectomy were done and the patient received four pints of packed red blood cells. Uneventful post-operative course followed and the woman was discharged seven days later.

Bottom Line: We performed an excision of the rudimentary horn with ipsilateral salpingectomy.Post-operative course was uneventful and the woman was discharged seven days later.This case emphasizes the importance of good antenatal care to avoid complications.

View Article: PubMed Central - PubMed

Affiliation: Obstetrics and Gynecology Unit of the Yaounde Central Hospital, Yaounde, Cameroon.

ABSTRACT
Rudimentary uterine horn pregnancy is rare and, to our knowledge, has not been previously reported in Cameroon. We herein report the case of a 22 year old second gravida referred for acute abdominal pain at 17 weeks of gestation. Physical examination revealed hemoperitoneum with hypovolemic shock. After resuscitation, an emergency exploratory laparotomy was done and we found hemoperitoneum of 3,500 milliliters, a bicornuate uterus with a ruptured right rudimentary communicating horn containing a non viable foetus. There were no other abnormalities. We performed an excision of the rudimentary horn with ipsilateral salpingectomy. Post-operative course was uneventful and the woman was discharged seven days later. This case emphasizes the importance of good antenatal care to avoid complications.

Show MeSH
Related in: MedlinePlus