Sir,We would like to report the rare occurrence of a pregnancy in a non-communicating rudimentary uterine horn in an obese woman which evaded diagnosis, ruptured, and resulted in major intra-abdominal hemorrhage.A nulliparous woman, with a BMI of 36, presented at 21 weeks' gestation with a history of abdominal pain. Prior to that time, the pregnancy had been uneventful with ultrasound (US) scans at 13~(+0) and 19~(+3) weeks which reported a normal pregnancy. Over a 10-day period she was admitted on three occasions, during which time several different diagnoses including cholecystitis and gastrointestinal bleeding were considered. At each admission, a US scan reported a normal pregnancy. The patient had endoscopy, CT scans and a focused assessment with sonography in trauma (FAST) procedure (1). At her final admission she presented with pain, signs and symptoms of hypovo-lemic shock, and low hemoglobin despite blood transfusion. A laparotomy was performed with a putative diagnosis of a ruptured spleen. A 5-L hemoperitoneum was discovered and a large mass on the right side of the uterus which showed signs of dehiscence and bleeding from large veins. The mass was determined to be a right-sided rudimentary uterine horn with its own Fallopian tube and a normal sized uterus (Figure 1). Ultrasound revealed a fetus in the horn and an empty uterus. For maternal safety, excision of the rudimentary horn was performed. No communication to the endometrial cavity was seen. The postoperative period was uneventful. Some 18 months later she conceived again and had an emergency cesarean section at 36 weeks due to uterine pain. Mother and baby did well.
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