The infected hematometra in a rudimentary noncommunicating horn misdiagnosed as pelvic mass: A case report

INTRODUCTION: The rudimentary noncommunicating horn with a functional endometrial cavity is rare and often challenging to diagnose because of the variety in clinical features. We present a case of a patient for whom the diagnosis of a uterine horn was missed during the prior cesarean section, which later successfully treated with robotic-assisted laparoscopic removal of a rudimentary noncommunicating horn of uterus and ipsilateral tube. PRESENTATION OF CASE: A 20-year old woman, gravida 3 para 2, presented with a complaint of acute and severe pelvic pain with fever. Multiple imaging modalities of pelvis and abdomen showed an 8 cm right-sided pelvic mass with a tubular structure adjacent to the uterus. The pelvic inflammatory disease was diagnosed and treated with intravenous antibiotics. After reviewing multiple radiology images, Müllerian anomaly was suspected, and the rudimentary horn with the fallopian tube was confirmed via diagnostic hysteroscopy and laparoscopy. Subsequently, robotic-assisted laparoscopic removal of the right horn with the fallopian tube was performed. DISCUSSION: Assessment of a rudimentary noncommunicating horn with unicornuate uterus can be achieved by several radiology methods, including computed tomography, magnetic resonance imaging, two and 3-dimensional ultrasonography, hysterosalpingogram, and sonohysterography. In addition, evaluation of concomitant skeletal and renal anomalies is essential in enhancing diagnostic accuracy. In our case, the Müllerian anomaly with delayed onset complications was diagnosed by multiple imaging studies and treated successfully. CONCLUSION: The early and correct diagnosis of the Müllerian anomaly remains difficult but essential as misdiagnosis can be associated with serious complications in patients.