Arch Gynecol Obstet (2010) 282:121–125 DOI 10.1007/s00404-009-1212-z 123 MATERNO-FETAL MEDICINE Laparoscopic management of a 16-week ruptured rudimentary horn pregnancy: a case and literature review Anupama Shahid · Oladimeji Olowu · Gomathy Kandasamy · Charlie O’Donnell · Funlayo Odejinmi Received: 14 June 2009 / Accepted: 10 August 2009 / Published online: 25 August 2009  Springer-Verlag 2009 Abstract Introduction Pregnancy in a rudimentary horn is although rare, but is associated with the risk of rupture and life threatening hemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Manage- ment usually consists of excision of the rudimentary horn along with the pregnancy and the ipsilateral tube, tradition- ally by laparotomy. Materials and methods We present a case of a 16-week ruptured rudimentary horn pregnancy diagnosed intraoper- atively and managed laparoscopically in the presence of massive haemoperitoneum, which is Wrst of its kind along with literature review. Conclusion This case demonstrates that laparoscopy is a feasible approach and can provide rapid diagnosis and con- trol of bleeding in such cases provided there is availability of eYcient multi-disciplinary teamwork, optimal anesthe- sia, advanced cardiovascular monitoring, laparoscopic expertise and ability to convert rapidly to laparotomy if required. Keywords Rudimentary horn pregnancy · Ruptured uterine rudimentary horn · Laparoscopy Introduction The incidence of rudimentary horn pregnancy has been reported to be 1 in 76,000–150,000 pregnancies [1]. The unicornuate uterus with a rudimentary horn may be associated with complications such as hematometra, endo- metriosis, infertility, urinary tract anomalies, recurrent mis- carriages, preterm-labor, malpresentation and placenta accreta [2]. Delay in diagnosis and hemorrhage may result in an adverse outcome of pregnancy in such cases [3]. Prompt intervention is necessary to remove the horn and its tube when a diagnosis of pregnancy is made [4]. With increasing expertise in laparoscopy, the traditional approach of choice—laparotomy is being replaced [4–8]. We present the Wrst report in literature on laparoscopic management of a ruptured rudimentary horn pregnancy at 16 weeks gestation in the presence of massive hemoperitoneum. Case report A 33-year old G3P0 who was 16 weeks and 5 days preg- nant presented with lower abdominal and right shoulder tip pain of 10 h duration and three syncopal attacks to our Accident and Emergency Department. A previous laparoscopy at 7 weeks for lower abdominal pain at a diVerent hospital reported that the pregnancy was developing in a bicornuate uterus with equally developed horns. Her previous pregnancies needed surgical evacuation at 17 and 9 weeks for incomplete and missed miscarriages respectively. She did not have any pre-conceptional work up for miscarriages or uterine abnormality. She had no other signiWcant history of note. A. Shahid · O. Olowu · F. Odejinmi (&) Department of Obstetrics and Gynecology, Whipps Cross University Hospital, London E11 1NR, UK e-mail: jimi@doctors.org.uk G. Kandasamy Department of Anesthesia, Whipps Cross University Hospital, London E11 1NR, UK C. O’Donnell Department of Accident and Emergency, Whipps Cross University Hospital, London E11 1NR, UK