Human Reproduction, Vol. 15, No. 8, 1873,
August 2000
© 2000 European Society of Human Reproduction and Embryology
Letters to the editor |
Laparascopic management of a unicornuate uterus with two cavitated, non-communicating rudimentary horns
Service de Gynécologie, Université Catholique de Louvain, Cliniques Universitaires St Luc, Avenue Hippocrate, 10, B–1200 Bruxelles, Belgium, E-mail: donnez{at}gyne.ucl.ac.be
Dear Sir,
We read with interest the description of the Müllerian anomaly by Nezhat and Smith (1999). The authors suggested that this case of a unicornuate uterus accompanied by two rudimentary horns is unique in the literature. Indeed, according to the American Fertility Society (AFS) classification (1988), such a Müllerian anomaly has never been described.
The authors described two remnants not communicating with the uterus nor each other. As the lower remnant was noted to extend partially into the vagina but without opening into it, we suggest another classification of this Müllerian anomaly. It could be a double uterus with cervical atresia on the right side, with an inflammatory reaction and progressive stricture between the endocervical canal and the uterine cavity. As the diagnosis was made 3 years after the menarche, the progressive accumulation of menstrual debris could induce some inflammatory reactions. This malformation is probably a variant of the double uterus with a blind hemivagina, where ipsilateral kidney absence is systematically observed (as in this case). Was it not possible to perform drainage of the collection through the vagina, trying to preserve the `blind' uterus? Finally, pathology findings could also be in favour of a uterus with cervical atresia.
It is difficult to understand why the authors removed the right ovary even if there were adhesions between the tube and the ovary. In Figure 1, the right haematosalpinx was not represented, thus this does not correlate with the description given in the text.
The review of the literature by Amara et al. (Amara et al., 1997
), adopted by the authors is now incomplete. Indeed, the authors claimed that in the world literature, only 16 cases of laparoscopic resection of rudimentary horns have been published. However, in 1996, Donnez and Nisolle described the laparoscopic technique of hemihysterectomy in 14 cases of rudimentary horns.
In conclusion, the denomination `unicornuate uterus with two rudimentary horns' may not be the right one. Indeed from an embryogenetic point of view, it is quite impossible to understand the author's hypothesis.
References
Amara, D.P., Nezhat, F., Giudice, L. et al. (1997) Laparoscopic management of a non-communicating uterine horn in a patient with an acute abdomen. Surg. Laparosc. Endosc., 7, 56–59[Web of Science][Medline]
American Fertility Society (1988) The AFS classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil. Steril., 49, 944–955[Web of Science][Medline]
Donnez, J. and Nisolle, M. (1997) Shall we operate on a Müllerian defect? Endoscopic laser treatment of uterine malformations. Hum. Reprod., 12, 1381–1387[Abstract]
Nezhat, C.R. and Smith, K.S. (1999) Laparoscopic management of a unicornuate uterus with two cavitated, non-communicating rudimentary horns. Hum. Reprod., 14, 1965–1968.
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  P. Acien Unicornuate uterus with two cavitated, non-communicating rudimentary horns? Hum. Reprod., February 1, 2001; 16(2): 393 - 395. [Full Text] [PDF]
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