Ruptured non-communicating horn of bicornuate uterus at 22 weeks of gestation presenting as hypovoluemic shock: a case report

Abstract

Pregnancy in a non-communicating rudimentary horn is a rare form of ectopic pregnancy resulting from a müllerian duct anomaly and is associated with a high risk of uterine rupture (50-90%), massive intraperitoneal hemorrhage, and maternal morbidity. Diagnosis before rupture remains challenging due to nonspecific clinical presentation and limitations of imaging. This case is presented to highlight the importance of early recognition, prompt surgical management, and the possibility of successful subsequent pregnancy following excision of a ruptured rudimentary horn. A 33-year-old, G2P1L1 woman with a previous lower segment cesarean section, history of infertility treatment, and hypothyroidism presented at 22+1 weeks of gestation with acute abdominal pain, syncope, and hypovoluemic shock. Emergency laparotomy revealed rupture of a right non-communicating rudimentary horn with hemoperitoneum. Excision of the ruptured rudimentary horn with right salpingo-oophorectomy was performed, and the patient recovered following massive blood transfusion. One year later, she conceived spontaneously. Despite developing complete placenta previa, gestational diabetes mellitus, and hypothyroidism, she underwent emergency lower segment cesarean section at 31+2 weeks of gestation, resulting in the delivery of a healthy preterm male infant. Rudimentary horn pregnancy should be considered in women with acute abdominal pain and hemodynamic instability during the second trimester, even when a previous diagnosis of intrauterine pregnancy has been made. Because rupture commonly occurs before diagnosis, maintaining a high index of suspicion is crucial. Surgical excision remains the definitive treatment for ruptured cases. This report highlights that successful subsequent pregnancy is achievable following appropriate surgical management and careful antenatal surveillance.