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Human Reproduction, Vol. 17, No. 5, 1343-1344, May 2002
© 2002 European Society of Human Reproduction and Embryology

Complex Müllerian malformation: report of a case with a hypoplastic non-cavitated uterus and two rudimentary horns: Case report

Salih Sadik1, Omur Taskin2,3,4, Salim Sehirali1, Inanc Mendilcioglu2, A.Seçkin Önoglu1, Sinan Kursun2 and James M. Wheeler3

1 Departments of Obstetrics and Gynecology, 1SSK Tepecik Hospital, Izmir, 2 Akdeniz University School Of Medicine, Antalya, Turkey and 3 Center for Women's Health and Research, Houston, USA

Various classifications have been used for congenital anomalies of the Müllerian system. We report a case of a previously unknown anomaly of the uterus, and propose its possible embryological causes. The patient presented with primary amenorrhoea and infertility, and during laparoscopy three distinct uterine horns were observed. The tubes were connected to the two most lateral horns, each juxtaposed to a normal ovary. The middle horn had a seemingly normal attachment to the right uterosacral ligament, whereas its attachment to the left uterosacral ligament appeared attenuated and less normal. Furthermore, the right horn was immediately attached to the middle horn, whereas the left horn was, like its ipsilateral uterosacral ligament, attached to the middle horn by a more attenuated, stretched fibrous bridge. Only the middle horn, with its uterosacral ligaments, had an attached, although obstructed, cervix. Ultrasonographic examination revealed no endometrium echogeneity in any of these uterine bulbs. No etiologic factors were noted in the patient's history; her mother denied known ingestion of estrogens or other drugs while carrying her daughter. The pathogenesis of this anomaly cannot be clearly defined, but may involve sequential embryological errors of duplication of the Müllerian tracts, failure of fusion of each set of the Müllerian tracts with expected failed canalization of each tract and, finally, agenesis of the medial horn of the left duplicated tracts.

Key words: Müllerian defects/rudimentary horn/uterine anomaly

4 To whom correspondence should be addressed at: Akdeniz University School Of Medicine, Department of Obstetrics and Gynecology, Antalya, Turkey. E-mail: Omurtaskin{at}hotmail.com


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